401
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Kereiakes DJ, Hill JM, Ben-Yehuda O, Maehara A, Alexander B, Stone GW. Evaluation of safety and efficacy of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses: Design and rationale for the Disrupt CAD III trial. Am Heart J 2020; 225:10-18. [PMID: 32470635 DOI: 10.1016/j.ahj.2020.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
Coronary calcification limits optimal stent expansion and apposition and worsens safety and effectiveness outcomes of percutaneous coronary intervention (PCI). Current ablative technologies that modify calcium to optimize stent deployment are limited by guidewire bias and periprocedural complications related to atheroembolization, coronary dissection, and perforation. Intravascular lithotripsy (IVL) delivers pulsatile ultrasonic pressure waves through a fluid-filled balloon into the vessel wall to modify calcium and enhance vessel compliance, reduce fibroelastic recoil, and decrease the need for high-pressure balloon (barotrauma) inflations. IVL has been used in peripheral arteries as stand-alone revascularization or as an adjunct to optimize stent deployment. STUDY DESIGN AND OBJECTIVES: Disrupt CAD III (clinicaltrials.gov identifier: NCT03595176) is a prospective, multicenter, single-arm study designed to assess safety and efficacy of the Shockwave coronary IVL catheter to optimize coronary stent deployment in patients with de novo calcified coronary stenoses. The primary safety end point is freedom from major adverse cardiovascular events (composite of cardiac death, myocardial infarction, and target vessel revascularization) at 30 days compared to a prespecified performance goal. The primary effectiveness end point is procedural success without in-hospital major adverse cardiovascular events. Enrollment will complete early in 2020 with clinical follow-up ongoing for 2 years. CONCLUSION: Disrupt CAD III will evaluate the safety and effectiveness of the Shockwave coronary IVL catheter to optimize coronary stent deployment in patients with calcified coronary stenoses.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital and Lindner Research Center, Cincinnati, OH.
| | | | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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402
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Gargiulo G, Esposito G, Avvedimento M, Nagler M, Minuz P, Campo G, Gragnano F, Manavifar N, Piccolo R, Tebaldi M, Cirillo P, Hunziker L, Vranckx P, Leonardi S, Heg D, Windecker S, Valgimigli M. Cangrelor, Tirofiban, and Chewed or Standard Prasugrel Regimens in Patients With ST-Segment-Elevation Myocardial Infarction: Primary Results of the FABOLUS-FASTER Trial. Circulation 2020; 142:441-454. [PMID: 32795098 PMCID: PMC7392586 DOI: 10.1161/circulationaha.120.046928] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Standard administration of newer oral P2Y12 inhibitors, including prasugrel or ticagrelor, provides suboptimal early inhibition of platelet aggregation (IPA) in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention. We aimed to investigate the effects of cangrelor, tirofiban, and prasugrel, administered as chewed or integral loading dose, on IPA in patients undergoing primary percutaneous coronary intervention. Methods: The FABOLUS-FASTER trial (Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over Prasugrel: A Multicenter Randomized Open-Label Trial in Patients with ST-Elevation Myocardial Infarction Referred for Primary Percutaneous Intervention) is an investigator-initiated, multicenter, open-label, randomized study. A total of 122 P2Y12-naive patients with ST-segment–elevation myocardial infarction were randomly allocated (1:1:1) to cangrelor (n=40), tirofiban (n=40) (both administered as bolus and 2-hour infusion followed by 60 mg of prasugrel), or 60-mg loading dose of prasugrel (n=42). The latter group underwent an immediate 1:1 subrandomization to chewed (n=21) or integral (n=21) tablets administration. The trial was powered to test 3 hypotheses (noninferiority of cangrelor compared with tirofiban using a noninferiority margin of 9%, superiority of both tirofiban and cangrelor compared with chewed prasugrel, and superiority of chewed prasugrel as compared with integral prasugrel, each with α=0.016 for the primary end point, which was 30-minute IPA at light transmittance aggregometry in response to 20 μmol/L adenosine diphosphate. Results: At 30 minutes, cangrelor did not satisfy noninferiority compared with tirofiban, which yielded superior IPA over cangrelor (95.0±8.9 versus 34.1±22.5; P<0.001). Cangrelor or tirofiban were both superior to chewed prasugrel (IPA, 10.5±11.0; P<0.001 for both comparisons), which did not provide higher IPA over integral prasugrel (6.3±11.4; P=0.47), despite yielding higher prasugrel active metabolite concentration (ng/mL; 62.3±82.6 versus 17.1±43.5; P=0.016). Conclusions: Cangrelor provided inferior IPA compared with tirofiban; both treatments yielded greater IPA compared with chewed prasugrel, which led to higher active metabolite concentration but not greater IPA compared with integral prasugrel. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02978040; URL: https://www.clinicaltrialsregister.eu; EudraCT 2017-001065-24.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G., G.E., M.A., R.P., P.C.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G., G.E., M.A., R.P., P.C.)
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G., G.E., M.A., R.P., P.C.)
| | - Michael Nagler
- University Institute of Clinical Chemistry, Inselspital (M.N.), University of Bern, Switzerland
| | - Pietro Minuz
- Department of Medicine, Unit of General Medicine for the Study and Treatment of Hypertensive Disease, University of Verona, Policlinico GB Rossi, Italy (P.M.)
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Italy (G.C., M.T.)
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (G.C.)
| | - Felice Gragnano
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy (F.G.)
| | - Negar Manavifar
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G., G.E., M.A., R.P., P.C.)
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Italy (G.C., M.T.)
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G., G.E., M.A., R.P., P.C.)
| | - Lukas Hunziker
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Belgium (P.V.)
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S Matteo, Italy (S.L.)
| | - Dik Heg
- Bern University Hospital, and Clinical Trials Unit, CTU Bern (D.H.), University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology (G.G., F.G., N.M., L.H., S.W., M.V.), University of Bern, Switzerland
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403
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Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation. Ann Intensive Care 2020; 10:83. [PMID: 32548658 PMCID: PMC7296889 DOI: 10.1186/s13613-020-00701-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/11/2020] [Indexed: 01/31/2023] Open
Abstract
Background Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This study evaluated whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients undergoing veno-arterial (VA) ECMO. Methods A total of 255 AMI patients who underwent VA-ECMO were included. In January 2014, a multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into a pre-ECMO team group (n = 131) and a post-ECMO team group (n = 124). The primary outcome was in-hospital mortality. Results In-hospital mortality (pre-ECMO team vs. post-ECMO team, 54.2% vs. 33.9%; p = 0.002) and cardiac intensive care unit mortality (pre-ECMO team vs. post-ECMO team, 51.9% vs. 30.6%; p = 0.001) were significantly lower after the implementation of a multidisciplinary ECMO team. On multivariable logistic regression model, implementation of the multidisciplinary ECMO team was associated with reduction of in-hospital mortality [odds ratio: 0.37, 95% confidence interval (CI) 0.20–0.67; p = 0.001]. Incidence of all-cause mortality [58.3% vs. 35.2%; hazard ratio (HR): 0.49, 95% CI 0.34–0.72; p < 0.001) and readmission due to heart failure (28.2% vs. 6.4%; HR: 0.21, 95% CI 0.08–0.58; p = 0.003) at 6 months of follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group. Conclusions Implementation of a multidisciplinary ECMO team was associated with improved clinical outcomes in AMI patients complicated by CS. Our data support that a specialized ECMO team is indispensable for improving outcomes in patients with AMI complicated by CS.
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404
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Yerasi C, Case BC, Forrestal BJ, Waksman R. Review of CRT 2020 Late-breaking Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:707-711. [PMID: 32349943 DOI: 10.1016/j.carrev.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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405
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Periprocedural Myocardial Injury: Pathophysiology, Prognosis, and Prevention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1041-1052. [PMID: 32586745 DOI: 10.1016/j.carrev.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/27/2023]
Abstract
The definition and clinical implications of myocardial infarction occurring in the setting of percutaneous coronary intervention have been the subject of unresolved controversy. The definitions of periprocedural myocardial infarction (PMI) are many and have evolved over recent years. Additionally, the recent advancement of different imaging modalities has provided useful information on a patients' pre-procedural risk of myocardial infarction. Nonetheless, questions on the benefit of different approaches to prevent PMI and their practical implementation remain open. This review aims to address these questions and to provide a current and contemporary perspective.
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406
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Cubero-Gallego H, Millán R, Fuertes M, Amat-Santos I, Quiroga X, Gómez-Lara J, Salvatella N, Tizón-Marcos H, Negrete A, Santos-Martínez S, Mohandes M, Gómez-Hospital JA, Morís C, Vaquerizo B. Coronary lithoplasty for calcified lesions: real-world multicenter registry. ACTA ACUST UNITED AC 2020; 73:1003-1010. [PMID: 32430261 DOI: 10.1016/j.rec.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary lithoplasty (CL) is a balloon-based technique used to treat calcified lesions. This study reports the initial experience of treatment of calcified lesions with CL in an unselected and high-risk population. METHODS This was a prospective, multicenter registry, which included all consecutive cases with calcified coronary lesions that underwent CL between August, 2018 and August, 2019. Exclusion criteria consisted of a target lesion located in a small vessel (< 2.5mm) and the presence of dissection prior to CL. Quantitative coronary angiography and intravascular ultrasound/optical coherence tomography analysis were completed by an independent central core laboratory. RESULTS This registry included 57 patients (66 lesions). The population was elderly (72.6±9.4 years) with high proportions of patients with diabetes (56%), chronic kidney disease (35%), and multivessel disease (84%). All lesions were classified as type B/C. More than 75% of lesions were predilated with noncompliant/semicompliant balloons or cutting-balloon. Rotablator was used in 5 lesions (7.6%) prelithoplasty. On average, CL required 1.17 balloons delivering a mean of 60 pulses. Successful CL was achieved in 98%. In 13% of cases, lithoplasty balloon was broken during therapy. There were few procedural complications: 2 cases of significant dissections (none related to lithoplasty balloon rupture) were successfully treated with drug-eluting stent implantation. One patient experienced stent thrombosis 2 days after successfully undergoing target lesion revascularization. CONCLUSIONS This is a real-world multicenter registry, which supports the feasibility, safety, and short-term efficacy of PCI for calcified coronary lesions using CL in an unselected and high-risk population with promising results.
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Affiliation(s)
- Héctor Cubero-Gallego
- Área del Corazón, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias-ISPA, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Raúl Millán
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Fuertes
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Joan XXIII, Universidad Rovira y Virgili, Tarragona, Spain
| | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares-CIBERCV, Instituto de Ciencias del Corazón-ICICOR, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Xavier Quiroga
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Josep Gómez-Lara
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Neus Salvatella
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Helena Tizón-Marcos
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas-IMIM, Barcelona, Spain
| | - Alejandro Negrete
- Instituto Hospital del Mar de Investigaciones Médicas-IMIM, Barcelona, Spain
| | - Sandra Santos-Martínez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares-CIBERCV, Instituto de Ciencias del Corazón-ICICOR, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mohsen Mohandes
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Joan XXIII, Universidad Rovira y Virgili, Tarragona, Spain
| | - Joan A Gómez-Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias-ISPA, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas-IMIM, Barcelona, Spain.
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407
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Tovar Forero MN, Scarparo P, den Dekker W, Balbi M, Masdjedi K, van Zandvoort L, Kardys I, Ameloot K, Daemen J, Lemmert M, Wilschut J, de Jaegere P, Zijlstra F, Van Mieghem N, Diletti R. Revascularization Strategies in Patients Presenting With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 125:1486-1491. [PMID: 32200948 DOI: 10.1016/j.amjcard.2020.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
The optimal revascularization strategy for residual coronary stenosis following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains controversial. This is a retrospective single-centre study including patients with STEMI and MVD. Based on the revascularization strategy, 3 groups were identified: (1) culprit only (CO), (2) ad hoc multivessel revascularization (MVR), and (3) staged MVR. Clinical outcomes were compared in terms of major adverse cardiac events (MACE), a composite of cardiac death, any myocardial infarction, and any unplanned revascularization at a long-term follow-up. A total of 958 patients were evaluated, 489 in the CO, 254 in the ad hoc, and 215 in the staged group. In the staged group, 65.6% of the patients received planned percutaneous coronary intervention, 9.7% coronary artery bypass grafting, 8.4% no further intervention after lesion reassessment, and in 16.3% an event occurred before the planned procedure. At 1,095 days, MACE was 36.1%, 16.7%, and 31% for CO, ad hoc, and staged groups, respectively. A MVR strategy was associated with lower rate of all-cause death compared with CO (HR 0.50; 95%CI [0.31 to 0.80]; p = 0.004). Complete revascularization reduced the rate of MACE (HR 0.30 [0.21 to 0.43] p < 0.001) compared with incomplete revascularization. Ad hoc MVR had lower rate of MACE compared with staged MVR (HR 0.61 [0.39 to 0.96] p = 0.032) mainly driven by less unplanned revascularizations. In conclusion, in patients with STEMI and MVD, complete revascularization reduced the risk of MACE. Ad hoc MVR appeared a reasonable strategy with lower contrast and stent usage and costs.
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Affiliation(s)
| | - Paola Scarparo
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand den Dekker
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthew Balbi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laurens van Zandvoort
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Miguel Lemmert
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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408
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Moroni F, Arrivi A, Pucci G, Azzalini L. Rotational atherectomy: once again on stage. Minerva Cardioangiol 2020; 68:123-125. [DOI: 10.23736/s0026-4725.20.05240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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409
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Dehmer GJ, Badhwar V, Bermudez EA, Cleveland JC, Cohen MG, D'Agostino RS, Ferguson TB, Hendel RC, Isler ML, Jacobs JP, Jneid H, Katz AS, Maddox TM, Shahian DM. 2020 AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization). J Am Coll Cardiol 2020; 75:1975-2088. [PMID: 32217040 DOI: 10.1016/j.jacc.2020.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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410
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Katsura A, Minami Y, Kato A, Muramatsu Y, Sato T, Hashimoto T, Meguro K, Shimohama T, Ako J. Novel volumetric analysis for stent expansion after drug-eluting stent implantation: An optical coherence tomography study. Catheter Cardiovasc Interv 2020; 96:E501-E507. [PMID: 32202053 DOI: 10.1002/ccd.28871] [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: 12/26/2019] [Revised: 03/07/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the clinical significance of a novel optical coherence tomography (OCT)-derived volumetric parameter of stent expansion by comparing it with the conventional parameters in real-world practice. BACKGROUND The clinical significance of novel parameters in real-world practice including longer and smaller stents remains to be elucidated. METHODS A total of 226 de novo lesion treated with drug-eluting stents in 208 consecutive patients were enrolled. Stent expansion was retrospectively assessed on the final OCT images after stent implantation. The novel parameter was the minimum expansion index (MEI) calculated using a novel algorithm that yields the ideal lumen area in each frame by taking into account vessel tapering. The device-oriented clinical end point (DoCE) included cardiac death, target vessel-related myocardial infarction, ischemia-driven target lesion revascularization. RESULTS The MEI in the lesions with a DoCE (n = 22) at 2 years and cases without a DoCE (n = 204) was 64.3 ± 12.0% and 78.5 ± 14.6%, respectively (p < .001). In the receiver operating characteristic curve analyses, the areas under the curve for the MEI (0.787; p < .001) were larger than that for %stent expansion (0.718; p = .001) and minimum stent area (0.664; p = .004) in predicting the DoCE. The best cutoff of MEI for predicting the DoCE was 74.0. CONCLUSIONS The novel MEI was better than the conventional %stent expansion and minimum stent area for predicting DoCE.
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Affiliation(s)
- Aritomo Katsura
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ayami Kato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yusuke Muramatsu
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Toshimitsu Sato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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411
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Dehmer GJ, Badhwar V, Bermudez EA, Cleveland JC, Cohen MG, D'Agostino RS, Ferguson TB, Hendel RC, Isler ML, Jacobs JP, Jneid H, Katz AS, Maddox TM, Shahian DM. 2020 AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization). Circ Cardiovasc Qual Outcomes 2020; 13:e000059. [PMID: 32202924 DOI: 10.1161/hcq.0000000000000059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Robert C Hendel
- Former Task Force Chair during this writing effort.,Task Force Liaison
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412
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Nakajima A, Araki M, Kurihara O, Minami Y, Soeda T, Yonetsu T, Crea F, Takano M, Higuma T, Kakuta T, Adriaenssens T, Lee H, Nakamura S, Jang I. Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome. Catheter Cardiovasc Interv 2020; 97:634-645. [DOI: 10.1002/ccd.28847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Akihiro Nakajima
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Makoto Araki
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Osamu Kurihara
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Kanagawa Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine Nara Medical University Kashihara Nara Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Science Catholic University of the Sacred Heart, Fondazione Policlinico Agostino Gemelli IRCCS Roma Italy
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Tsunekazu Kakuta
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki Japan
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine University Hospitals Leuven Leuven Belgium
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Sunao Nakamura
- Interventional Cardiology Unit New Tokyo Hospital Chiba Japan
| | - Ik‐Kyung Jang
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Division of Cardiology Kyung Hee University Hospital Seoul South Korea
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413
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Clinical expert consensus document on quantitative coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2020; 35:105-116. [PMID: 32125622 PMCID: PMC7105443 DOI: 10.1007/s12928-020-00653-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/15/2023]
Abstract
Quantitative coronary angiography (QCA) remains to play an important role in clinical trials and post-marketing surveillance related to the safety and efficacy of new PCI devices. In this document, the current standard methodology of QCA is summarized. In addition, its history, recent development and future perspectives are also reviewed.
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414
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Combined Vascular Brachytherapy and Stenting for the Treatment of In-Stent Restenosis. Am J Cardiol 2020; 125:712-719. [PMID: 31889523 DOI: 10.1016/j.amjcard.2019.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022]
Abstract
In-stent restenosis (ISR) remains a therapeutic challenge in the current drug-eluting stent (DES) era. Vascular brachytherapy (VBT) is a therapeutic option for ISR, but data about the outcomes of combination therapy with VBT and stenting for ISR lesions are sparse. We retrospectively analyzed patients who presented with ISR at our institution from 2003 through 2017. Three treatment arms were compared: VBT alone, VBT plus bare-metal stent (BMS), and VBT plus DES. Clinical, procedural, and 1-year outcome data were collected. Follow-up was obtained by phone calls and clinic visits. The patient cohort included 461 patients (764 ISR lesions). Of these, 333 patients (533 lesions) were treated with VBT alone, 89 patients (158 lesions) with VBT plus BMS, and 39 patients (73 lesions) with VBT plus DES. There were no significant differences in baseline characteristics among the 3 groups except for more patients with a remote smoking history in the VBT plus BMS (43.8%) and VBT plus DES groups (56.4%), and more patients with history of peripheral vascular disease (39.5%) and congestive heart failure (27%) in the VBT plus DES group. The most common clinical presentation was unstable angina (64.6%). In the VBT plus DES group, 10.3% of patients presented with MI, versus 5.5% in the VBT alone group and 2.2% in the VBT plus BMS group. At 1-year follow-up, the VBT plus DES group had higher rates of target vessel revascularization-major adverse cardiovascular events (38.5%) than the VBT plus BMS (21.3%) and VBT alone (15.6%) groups (p = 0.002). In conclusion, in patients with ISR, combination therapy with VBT and stenting at the same setup is associated with worse outcomes at 12 months and, if possible, should be avoided.
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415
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Mankerious N, Hemetsberger R, Traboulsi H, Toelg R, Abdel-Wahab M, Richardt G, Allali A. Predictors of In-Hospital Adverse Outcomes after Rotational Atherectomy: Impact of the Target Vessel SYNTAX Score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:754-759. [PMID: 32139281 DOI: 10.1016/j.carrev.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is an established treatment of calcified lesions, but has some inherent procedural hazards. However, predictors of in-hospital adverse outcomes after RA are poorly investigated. OBJECTIVE To explore the predictors of in-hospital adverse outcomes after RA and to introduce the target vessel SYNTAX score (tvSS) as a potential causal variable. METHODS Patients who underwent RA at our center (n = 323) were divided into two groups according to the occurrence of in-hospital adverse outcomes (a composite of residual stenosis ≥30%, persistent slow flow, dissection requiring additional stenting beyond the primary lesion, perforation, burr entrapment, and in-hospital major adverse cardiac events [MACE]). RESULTS In-hospital adverse outcomes were more frequent in patients with severely-tortuous target vessels or lesions >20 mm, while aorto-ostial and bifurcation lesions, as well as chronic total occlusion rates, were equally distributed among patients with and without adverse outcomes. TvSS was 18 [13-24] vs. 12 [8-17] in patients with vs. without in-hospital adverse outcomes (p < 0.001). A tvSS cut-off value of 15 showed 73% sensitivity and 62% specificity for predicting in-hospital adverse outcomes. TvSS emerged as an independent predictor for in-hospital adverse outcomes along with bailout RA and reduced left ventricular ejection fraction (LVEF). However, after one year, the occurrence of in-hospital adverse outcomes was not associated with an increase in the MACE rate (log-rank p = 0.857). CONCLUSION In-hospital adverse outcomes are higher in patients with more complex target vessel anatomies as indicated by a higher tvSS. Bailout RA and reduced LVEF emerged as additional predictors of in-hospital adverse outcomes.
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Affiliation(s)
- Nader Mankerious
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
| | - Rayyan Hemetsberger
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Hussein Traboulsi
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
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416
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Buchtele N, Herkner H, Schörgenhofer C, Merrelaar A, Laggner R, Gelbenegger G, Spiel AO, Domanovits H, Lang I, Jilma B, Schwameis M. High Platelet Reactivity after Transition from Cangrelor to Ticagrelor in Hypothermic Cardiac Arrest Survivors with ST-Segment Elevation Myocardial Infarction. J Clin Med 2020; 9:jcm9020583. [PMID: 32098088 PMCID: PMC7073541 DOI: 10.3390/jcm9020583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
Transition from cangrelor to oral P2Y12 inhibitors after PCI carries the risk of platelet function recovery and acute stent thrombosis. Whether the recommended transition regimen is appropriate for hypothermic cardiac arrest survivors is unknown. We assessed the rate of high platelet reactivity (HPR) after transition from cangrelor to ticagrelor in hypothermic cardiac arrest survivors. Adult survivors of out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction (STEMI), who were treated for hypothermia (33 °C ± 1) and received intravenous cangrelor during PCI and subsequent oral loading with 180mg ticagrelor were enrolled in this prospective observational cohort study. Platelet function was assessed using whole blood aggregometry. HPR was defined as AUC > 46U. The primary endpoint was the rate of HPR (%) at predefined time points during the first 24 h after cangrelor cessation. Poisson regression was used to estimate the relationship between the overlap time of cangrelor and ticagrelor co-administration and the number of subsequent HPR episodes, expressed as incidence rate ratio (IRR) with 95% confidence interval (95%CI). Between December 2017 and October 2019 16 patients (81% male, 58 years) were enrolled. On average, ticagrelor was administered 39 min (IQR 5-50) before the end of cangrelor infusion. The rate of HPR was highest 90 min after cangrelor cessation and was present in 44% (7/16) of patients. The number of HPR episodes increased significantly with decreasing overlap time of cangrelor and ticagrelor co-administration (IRR 1.03, 95%CI 1.01-1.05; p = 0.005). In this selected cohort of hypothermic cardiac arrest survivors who received cangrelor during PCI, ticagrelor loading within the recommended time frame before cangrelor cessation resulted in a substantial amount of patients with HPR.
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Affiliation(s)
- Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (N.B.); (C.S.); (G.G.); (B.J.)
- Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (H.H.); (A.M.); (H.D.); (M.S.)
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (N.B.); (C.S.); (G.G.); (B.J.)
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (H.H.); (A.M.); (H.D.); (M.S.)
| | - Roberta Laggner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (N.B.); (C.S.); (G.G.); (B.J.)
| | - Alexander O. Spiel
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (H.H.); (A.M.); (H.D.); (M.S.)
- Correspondence: ; Tel.: +43-1-40-400-39560
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (H.H.); (A.M.); (H.D.); (M.S.)
| | - Irene Lang
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (N.B.); (C.S.); (G.G.); (B.J.)
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (H.H.); (A.M.); (H.D.); (M.S.)
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417
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Saito Y, Cristea E, Bouras G, Abizaid A, Lutz M, Carrié D, Weber‐Albers J, Dudek D, Anderson J, Lansky A. Long‐term serial functional evaluation after implantation of the Fantom sirolimus‐eluting bioresorbable coronary scaffold. Catheter Cardiovasc Interv 2020; 97:431-436. [DOI: 10.1002/ccd.28804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yuichi Saito
- Yale University School of Medicine New Haven Connecticut USA
| | | | - Georgios Bouras
- Yale University School of Medicine New Haven Connecticut USA
| | | | - Matthias Lutz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | | | | | | | | | - Alexandra Lansky
- Yale University School of Medicine New Haven Connecticut USA
- Barts Heart Centre, London and Queen Mary University of London London UK
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418
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Chichareon P, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Botelho R, Eeckhout E, Hofma S, Trendafilova-Lazarova D, Kőszegi Z, Iñiguez A, Wykrzykowska JJ, Piek JJ, Garg S, Hamm C, Steg PG, Jüni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Serruys PW. Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study. Atherosclerosis 2020; 295:45-53. [DOI: 10.1016/j.atherosclerosis.2020.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/25/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
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419
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Spitzer E, McFadden E, Rademaker-Havinga T, Cutlip DE, Garcia-Garcia HM. Reply: Periprocedural PCI Myocardial Biomarker Elevation and Mortality. JACC Cardiovasc Interv 2020; 13:266-268. [PMID: 31973800 DOI: 10.1016/j.jcin.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
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420
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Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IBA, Trovik T, Kellerth T, Kalinauskas G, Mogensen LJH, Nielsen PH, Niemelä M, Lassen JF, Oldroyd K, Berg G, Stradins P, Walsh SJ, Graham ANJ, Endresen PC, Fröbert O, Trivedi U, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet 2020; 395:191-199. [PMID: 31879028 DOI: 10.1016/s0140-6736(19)32972-1] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used in revascularisation of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in the treatment of left main coronary artery disease and reported outcomes after a median follow-up of 3·1 years. We now report updated 5-year outcomes of the trial. METHODS The prospective, randomised, open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine northern European countries. Patients with left main coronary artery disease requiring revascularisation were enrolled and randomly assigned (1:1) to receive PCI or CABG. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, repeat revascularisation, and stroke. Non-inferiority of PCI to CABG was defined as the upper limit of the 95% CI of the hazard ratio (HR) not exceeding 1·35 after 275 MACCE had occurred. Secondary endpoints included all-cause mortality, non-procedural myocardial infarction, and repeat revascularisation. Outcomes were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01496651. FINDINGS Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were enrolled and allocated to PCI (n=598) or CABG (n=603), with 17 subsequently lost to early follow-up. 592 patients in each group were included in this analysis. At a median of 4·9 years of follow-up, the predefined number of events was reached for adequate power to assess the primary endpoint. Kaplan-Meier 5-year estimates of MACCE were 28% (165 events) for PCI and 19% (110 events) for CABG (HR 1·58 [95% CI 1·24-2·01]); the HR exceeded the limit for non-inferiority of PCI compared to CABG. CABG was found to be superior to PCI for the primary composite endpoint (p=0·0002). All-cause mortality was estimated in 9% after PCI versus 9% after CABG (HR 1·08 [95% CI 0·74-1·59]; p=0·68); non-procedural myocardial infarction was estimated in 8% after PCI versus 3% after CABG (HR 2·99 [95% CI 1·66-5·39]; p=0·0002); and repeat revascularisation was estimated in 17% after PCI versus 10% after CABG (HR 1·73 [95% CI 1·25-2·40]; p=0·0009). INTERPRETATION In revascularisation of left main coronary artery disease, PCI was associated with an inferior clinical outcome at 5 years compared with CABG. Mortality was similar after the two procedures but patients treated with PCI had higher rates of non-procedural myocardial infarction and repeat revascularisation. FUNDING Biosensors.
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Affiliation(s)
- Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Timo Mäkikallio
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - M Mitchell Lindsay
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Andrejs Erglis
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | | | - Thor Trovik
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Thomas Kellerth
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | | | - Per H Nielsen
- Department of Cardiac Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Geoffrey Berg
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Peteris Stradins
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | | | | | - Petter C Endresen
- Department of Cardiovascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | - Vesa Anttila
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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421
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Morice MC. Patients with left main coronary artery disease: stent or surgery? Lancet 2020; 395:167-168. [PMID: 31954444 DOI: 10.1016/s0140-6736(19)33224-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Marie-Claude Morice
- Institut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, 91300 Massy, France.
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422
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Costantini CR, Denk MA, De Macedo RM, Tarbine SG, Santos MF, Luize MM, Folador JC, Costantini CO, Stone GW. Absorb bioresorbable vascular scaffold outcomes following implantation with routine intravascular imaging guidance. Catheter Cardiovasc Interv 2020; 97:48-55. [DOI: 10.1002/ccd.28699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/22/2019] [Indexed: 01/15/2023]
Affiliation(s)
| | - Marcos A. Denk
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Rafael M. De Macedo
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Sergio G. Tarbine
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Marcelo F. Santos
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Marcio M. Luize
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | - Joao C. Folador
- Hospital Cardiologico Costantini and Fundação Francisco Costantini Curitiba Paraná Brazil
| | | | - Gregg W. Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and the Cardiovascular Research Foundation New York New York
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423
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Song L, Sun Z, Guan C, Yan H, Yu M, Cui J, Mu C, Qiu H, Tang Y, Zhao Y, Qiao S, Suryapranata H, Gao R, Xu B. First-in-man study of a thinner-strut sirolimus-eluting bioresorbable scaffold (FUTURE-I): Three-year clinical and imaging outcomes. Catheter Cardiovasc Interv 2020; 95 Suppl 1:648-657. [PMID: 31909884 DOI: 10.1002/ccd.28722] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The FUTURE-I study aimed to assess preliminary safety and effectiveness with the long-term clinical and imaging follow-up for the Firesorb (MicroPort, Shanghai, China), a thinner-strut sirolimus-eluting bioresorbable scaffold (BRS). BACKGROUND First-generation BRS has been associated with unexpected device-related adverse outcomes at long-term follow-up. METHODS In this prospective, open-label, first-in-man study, patients with single de novo lesions in native coronary arteries were randomized 2:1 into two cohorts after successful Firesorb implantation: cohort 1 (n = 30) underwent multimodality imaging assessment at 6 and 24 months; and cohort 2 (n = 15) at 12 and 36 months. All patients underwent clinical follow-up at 1, 6, and 12 months and annually up to 5 years. RESULTS Between January and March 2016, 45 patients were enrolled. At 3-year follow-up, one patient had experienced target lesion failure and none scaffold thrombosis. In-scaffold minimal lumen diameter decreased significantly from 6-month to 2-year (2.53 ± 0.24 mm vs. 2.27 ± 0.37 mm, p = .0003), and only numerically from 1-year to 3-year follow-up (2.48 ± 0.28 mm vs. 2.22 ± 0.13 mm, p = .08). By optical coherence tomography, neointimal strut coverage at 3-year follow-up was 99.8%, and very low rate of late scaffold discontinuity was observed, only in one patient on two cross sections with three malapposed struts. CONCLUSIONS At 3-year follow-up of the FUTURE-I study, implantation of the thinner-strut Firesorb BRS appeared preliminary feasible and effective in the treatment of patients with noncomplex coronary lesions.
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Affiliation(s)
- Lei Song
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongwei Sun
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingang Cui
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaowei Mu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yida Tang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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424
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Choe JC, Cha KS, Lee JG, Kim J, Shin JY, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH. Long-Term Outcomes of Biodegradable Versus Second-Generation Durable Polymer Drug-Eluting Stent Implantations for Myocardial Infarction. JACC Cardiovasc Interv 2020; 13:97-111. [DOI: 10.1016/j.jcin.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
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425
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Garg S, Chichareon P, Kogame N, Takahashi K, Modolo R, Chang C, Tomaniak M, Fath‐Ordoubadi F, Anderson R, Oldroyd KG, Stables RH, Kukreja N, Chowdhary S, Galasko G, Hoole S, Zaman A, Hamm CW, Steg PG, Jüni P, Valgimigli M, Windecker S, Onuma Y, Serruys PW. Impact of established cardiovascular disease on outcomes in the randomized global leaders trial. Catheter Cardiovasc Interv 2019; 96:1369-1378. [DOI: 10.1002/ccd.28649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Scot Garg
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust Blackburn UK
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam, Heart Center Amsterdam Netherlands
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Prince of Songkla University Songkhla Thailand
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam, Heart Center Amsterdam Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam, Heart Center Amsterdam Netherlands
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam, Heart Center Amsterdam Netherlands
- Department of Internal Medicine, Cardiology Division University of Campinas (UNICAMP). Campinas Brazil
| | | | - Mariusz Tomaniak
- Erasmus Medical Center, Thoraxcenter Rotterdam Netherlands
- First Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Farzin Fath‐Ordoubadi
- Manchester Heart Centre, Manchester Royal Infirmary Manchester University Foundation Trust Manchester UK
| | - Richard Anderson
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Keith G. Oldroyd
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Glasgow UK
| | | | - Neville Kukreja
- Department of Cardiology East and North Hertfordshire NHS Trust Hertfordshire UK
| | - Saqib Chowdhary
- Wythenshawe Hospital, Manchester University Foundation Trust Manchester UK
| | - Gavin Galasko
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust Blackpool UK
| | - Stephen Hoole
- Department of Interventional Cardiology Royal Papworth Hospital Cambridge UK
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine Newcastle University Newcastle‐upon‐Tyne UK
| | - Christian W. Hamm
- Kerckhoff Heart Center Campus University of Giessen Bad Nauheim Germany
| | - Philippe G. Steg
- FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP‐HP; Université Paris‐Diderot; and INSERM U‐1148 Paris France
- Royal Brompton Hospital Imperial College London UK
| | - Peter Jüni
- Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Canada
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland
| | | | - Yoshinobu Onuma
- Department of Cardiology National University of Ireland Galway Galway Ireland
| | - Patrick W. Serruys
- Department of Cardiology National University of Ireland Galway Galway Ireland
- NHLI, Imperial College London London UK
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426
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Lee JM, Rhee TM, Kim HK, Hwang D, Lee SH, Choi KH, Kim J, Park TK, Yang JH, Song YB, Choi JH, Choi SH, Koo BK, Chae SC, Cho MC, Kim CJ, Kim JH, Kim HS, Gwon HC, Jeong MH, Hahn JY. Comparison of Long-Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus Infarct-Related Artery-Only Revascularization for Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shock. J Am Heart Assoc 2019; 8:e013870. [PMID: 31818215 PMCID: PMC6951086 DOI: 10.1161/jaha.119.013870] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are limited regarding long‐term outcomes in patients with ST‐segment–elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3‐year clinical outcomes of patients with ST‐segment‐elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct‐related artery (IRA)–only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR‐NIH (Korea Acute Myocardial Infarction Registry––National Institutes of Health) registry, we selected 659 patients with ST‐segment‐elevation myocardial infarction who had concomitant non‐IRA stenosis and presented with cardiogenic shock. The primary outcome was all‐cause death. Multivessel PCI was performed in 260 patients and IRA‐only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all‐cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45–0.94 [P=0.024]), all‐cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41–0.84 [P=0.004]), and non‐IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10–0.50 [P<0.001]) than those in the IRA‐only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non‐IRA repeat revascularization beyond 1 year (log‐rank P=0.030 and P=0.017, respectively) than the IRA‐only PCI group. Conclusions In patients with ST‐segment‐elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all‐cause death than IRA‐only PCI at 3 years, suggesting potential benefit of non‐IRA revascularization during the index hospitalization to improve long‐term clinical outcomes.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center Chosun University Hospital University of Chosun College of Medicine Gwangju Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Seung Hun Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Ki Hong Choi
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jihoon Kim
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Taek Kyu Park
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jeong Hoon Yang
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Young Bin Song
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jin-Ho Choi
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung-Hyuk Choi
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Shung Chull Chae
- Department of Internal Medicine Kyungpook National University Hospital Daegu Korea
| | - Myeong-Chan Cho
- Division of Cardiology Department of Internal Medicine Chungbuk National University Hospital Cheongju Korea
| | - Chong Jin Kim
- Department of Internal Medicine Kyunghee University College of Medicine Seoul Korea
| | - Ju Han Kim
- Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Myung Ho Jeong
- Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Joo-Yong Hahn
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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427
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Corballis NH, Wickramarachchi U, Vassiliou VS, Eccleshall SC. Duration of dual antiplatelet therapy in elective drug-coated balloon angioplasty. Catheter Cardiovasc Interv 2019; 96:1016-1020. [PMID: 31797532 DOI: 10.1002/ccd.28632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to answer whether 1-month duration of dual antiplatelet therapy (DAPT) is safe after elective drug-coated balloon only (DCB) angioplasty. BACKGROUND The duration of DAPT after elective DCB was called into question after the ESC Focused DAPT Update of 2017. Until then, a 1-month duration of DAPT was considered safe by national consensus groups (German, Italian, and Chinese) supported by data from prospective worldwide registries. The ESC Guidelines recommended a 6-month duration of DAPT based on evidence from in-stent restenosis randomized controlled trials only. METHODS Retrospective, real-world population, single-center analysis conducted from January 1, 2012 to March 31, 2017 in a high-volume, tertiary PCI center. Consecutive patients receiving 1-month duration of DAPT after elective DCB angioplasty were included. We identified a primary composite outcome of cardiac death, myocardial infarction and target lesion revascularization at 6-months. RESULTS A total of 303 patients (78.5% male) with mean age of 67 ± 12.5 were included. This incorporated 86.1% de novo lesions and 56.5% nonsmall (≥3 mm diameter) coronary arteries treated. There were no reported outcomes of lesion thrombosis, target vessel MI, target lesion revascularization or cardiac death at 6-months. There were two (0.6%) nontarget vessel MIs and one (0.3%) noncardiac death. CONCLUSION One-month duration of DAPT appears safe after elective DCB-only angioplasty, highlighting this strategy for patients at high-risk of bleeding. These results also show favorable clinical outcomes for de novo coronary artery disease and nonsmall coronary arteries treated with DCB-only angioplasty. A 1-month duration of DAPT appears a safe and attractive option.
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Affiliation(s)
- Natasha H Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Norwich, UK
| | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Norwich, UK
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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428
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Effect of Body Mass Index on Ischemic and Bleeding Events in Patients Presenting With Acute Coronary Syndromes (from the START-ANTIPLATELET Registry). Am J Cardiol 2019; 124:1662-1668. [PMID: 31585697 DOI: 10.1016/j.amjcard.2019.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
The protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients. For the purpose of this substudy, patients enrolled in the START-ANTIPLATELET registry were stratified according to body mass index (BMI) into 3 groups: normal, BMI <25 kg/m2; overweight, BMI: 25 to 29.9 kg/m2; obese, BMI ≥30 kg/m2. The primary end point was net adverse clinical end points (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. In n = 1,209 patients, n = 410 (33.9%) were normal, n = 538 (44.5%) were overweight and n = 261 (21.6%) were obese. Compared to the normal weight group, obese and overweight patients had a higher prevalence of cardiovascular risk factors but were younger, with a better left ventricular ejection fraction and lower PRECISE-DAPT score. At 1-year follow-up net adverse clinical endpoints was more frequently observed in normal than in overweight and obese patients (15.1%, 8.6%, and9.6%, respectively; p = 0.004), driven by a significantly higher rate of all-cause death (6.3%, 2.6%, and 3.8%, respectively; p = 0.008), whereas no significant differences were noted in terms of myocardial infarction, stroke, and major bleeding. When correcting for confounding variables, BMI loses its power in independently predicting outcomes, failing to confirm the obesity paradox in a real-world ACS population. In conclusion, our study conflicts the obesity paradox in real-world ACS population, and suggest that the reduced rate of adverse events and mortality in obese patients may be explained by relevant differences in the clinical risk profile and medications rather than BMI per se.
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429
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Kufner S, Joner M, Thannheimer A, Hoppmann P, Ibrahim T, Mayer K, Cassese S, Laugwitz KL, Schunkert H, Kastrati A, Byrne RA. Ten-Year Clinical Outcomes From a Trial of Three Limus-Eluting Stents With Different Polymer Coatings in Patients With Coronary Artery Disease. Circulation 2019; 139:325-333. [PMID: 30586724 DOI: 10.1161/circulationaha.118.038065] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New-generation drug-eluting stents offer the potential for enhanced late outcomes in comparison with early generation drug-eluting stents. However, assessment of extended long-term outcomes for these devices is lacking, especially regarding the comparison between new-generation drug-eluting stents with biodegradable or permanent polymers. The aim of this study is to compare the efficacy and safety of biodegradable polymer-based sirolimus-eluting stents (BP-SES; Yukon Choice PC) versus permanent polymer-based everolimus-eluting stents (PP-EES; Xience) versus early generation permanent polymer-based sirolimus-eluting stents (PP-SES; Cypher) at 10-year follow-up. METHODS Overall, 2603 patients were randomized to treatment with BP-SES (n=1299), PP-EES (n=652), or PP-SES (n=652). The primary end point of this analysis was major adverse cardiac event, the composite of death, myocardial infarction, or target lesion revascularization. The main secondary end point of interest was definite/probable stent thrombosis. Follow-up at 10 years was available in 83% of the study patients. RESULTS The 10-year incidence of major adverse cardiac event (BP-SES 47.7% versus PP-EES 46.0% versus PP-SES 54.9%, P=0.003) and mortality (BP-SES 31.8% versus PP-EES 30.3% versus PP-SES 37.2%, P=0.02) was different among the groups. Definite/probable stent thrombosis was not significantly different among the groups (BP-SES 1.8% versus PP-EES 2.5% versus PP-SES 3.7%, P=0.09). Definite stent thrombosis was significantly different among the groups (BP-SES 1.1% versus PP-EES 0.8% versus PP-SES 2.4%, P=0.03). There were no significant differences between BP-SES and PP-EES. CONCLUSIONS In this unique long-term outcome analysis, BP-SES and PP-EES showed comparable clinical outcomes out to 10 years. PP-SES had higher rates of major adverse cardiac events and definite stent thrombosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00598676.
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Affiliation(s)
- Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Anna Thannheimer
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Petra Hoppmann
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.)
| | - Tareq Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.)
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Karl-Ludwig Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
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430
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de Faria AP, Modolo R, Chichareon P, Chang CC, Kogame N, Tomaniak M, Takahashi K, Rademaker-Havinga T, Wykrzykowska J, de Winter RJ, Ferreira RC, Sousa A, Lemos PA, Garg S, Hamm C, Juni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Steg PG, Serruys PW. Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS. Can J Cardiol 2019; 36:747-755. [PMID: 32139280 DOI: 10.1016/j.cjca.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We evaluated the association of pulse pressure (PP) and different antiplatelet regimes with clinical and safety outcomes in an all-comers percutaneous coronary intervention (PCI) population. METHODS In this analysis of GLOBAL LEADERS (n = 15,936) we compared the experimental therapy of 23 months of ticagrelor after 1 month of dual-antiplatelet therapy (DAPT) vs standard DAPT for 12 months followed by aspirin monotherapy in subjects who underwent PCI and were divided into 2 groups according to the median PP (60 mm Hg). The primary end point (all-cause death or new Q-wave myocardial infarction) and the composite end points: patient-oriented composite end points (POCE), Bleeding Academic Research Consortium (BARC) 3 or 5, and net adverse clinical events (NACE) were evaluated. RESULTS At 2 years, subjects in the high-PP group (n = 7971) had similar rates of the primary end point (4.3% vs 3.9%; P = 0.058), POCE (14.9% vs 12.7%; P = 0.051), and BARC 3 or 5 (2.5% vs 1.7%; P = 0.355) and higher rates of NACE (16.4% vs 13.7%; P = 0.037) compared with the low-PP group (n = 7965). Among patients with PP < 60 mm Hg, the primary end point (3.4% vs 4.4%, adjusted hazard ratio [aHR] 0.77, 95% confidence interval [CI] 0.61-0.96), POCE (11.8% vs 13.5%, aHR 0.86, 95% CI 0.76-0.98), NACE (12.8% vs 14.7%, aHR 0.85, 95% CI 0.76-0.96), and BARC 3 or 5 (1.4% vs 2.1%, aHR 0.69, 95% CI 0.49-0.97) were lower with ticagrelor monotherapy compared with DAPT. The only significant interaction was for BARC 3 or 5 (P = 0.008). CONCLUSIONS After contemporary PCI, subjects with high PP levels experienced high rates of NACE at 2 years. In those with low PP, ticagrelor monotherapy led to a lower risk of bleeding events compared with standard DAPT.
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Affiliation(s)
| | - Rodrigo Modolo
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands; Cardiology Division. Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Ply Chichareon
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands; Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chun-Chin Chang
- Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Mariusz Tomaniak
- Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Joanna Wykrzykowska
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Rob J de Winter
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Rui C Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Amanda Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Pedro A Lemos
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Yoshinobu Onuma
- Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials, Hopital Bichat, Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, and Institut National de la Sante et de la Recherche Medicale U-1148, Paris, France; Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Patrick W Serruys
- Galway University Hospital, National University of Ireland, Galway, Ireland.
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431
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Health Economic Evaluation of an Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Coronary Stent Compared to a Thin, Durable-Polymer Everolimus-Eluting Stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:752-757. [DOI: 10.1016/j.carrev.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
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432
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Modolo R, Kogame N, Komiyama H, Chichareon P, de Vries T, Tomaniak M, Chang CC, Takahashi K, Walsh S, Lesiak M, Moreno R, Farrooq V, Escaned J, Banning A, Onuma Y, Serruys PW. Two years clinical outcomes with the state-of-the-art PCI for the treatment of bifurcation lesions: A sub-analysis of the SYNTAX II study. Catheter Cardiovasc Interv 2019; 96:10-17. [PMID: 31402574 DOI: 10.1002/ccd.28422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bifurcation PCI is associated with a lower rate of procedural success, especially in multivessel disease patients. We aimed to determine the impact of bifurcation treatment on 2-years clinical outcomes when a state-of-the-art PCI strategy (heart team decision-making using the SYNTAX score II, physiology guided coronary stenosis assessment, thin strut bioresorbable polymer drug-eluting stent, and intravascular ultrasound guidance) is followed. METHODS Three-vessel disease patients enrolled in the SYNTAX II trial (n = 454) were categorized in patients with (a) ≥1 treated bifurcation (n = 126), and (b) without bifurcation (n = 281). The primary endpoint was the occurrence of major adverse cardio and cerebrovascular events (MACCE-a composite of all-cause death, stroke, any myocardial infarction, or any revascularization) at 2 years. Secondary endpoints were the occurrence of target lesion failure (TLF) defined as cardiac death, target-vessel myocardial infarction and ischemia-driven target lesion revascularization, and the individual components of the composite primary endpoint, as well as stent thrombosis. RESULTS A total of 145 bifurcation were treated in 126 patients. At 2 years, MACCE occurred in 75/407 patients (20.7% for bifurcation versus 17.5% for nonbifurcation, hazard ratio [HR] of 1.28, CI95% 0.78-2.08, p = .32). TLF presented a trend toward higher occurrence in bifurcation (16.8% vs. 10.8%, HR 1.75, CI95% 0.99-3.09, p = .053). Definite stent thrombosis did not differ at 2-year between groups (0.8% for the bifurcation vs. 0.7% for the nonbifurcation, p = .92). CONCLUSION Bifurcation treatment in patients with three-vessel disease undergoing state-of-the-art PCI had similar event rate of MACCE but was associated with a trend toward higher incidence of TLF compared with nonbifurcation lesions.
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Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Hidenori Komiyama
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Mariusz Tomaniak
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chun Chin Chang
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon Walsh
- Department of Cardiology Belfast Health & Social Care Trust, Belfast, UK
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | - Raul Moreno
- Department of Cardiology, Hospital Universitario la Paz, Madrid, Spain
| | - Vasim Farrooq
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, UK
| | - Yoshinobu Onuma
- Cardialysis BV, Rotterdam, the Netherlands.,Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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433
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Bonaca MP, Olenchock BA, Salem JE, Wiviott SD, Ederhy S, Cohen A, Stewart GC, Choueiri TK, Di Carli M, Allenbach Y, Kumbhani DJ, Heinzerling L, Amiri-Kordestani L, Lyon AR, Thavendiranathan P, Padera R, Lichtman A, Liu PP, Johnson DB, Moslehi J. Myocarditis in the Setting of Cancer Therapeutics: Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology. Circulation 2019; 140:80-91. [PMID: 31390169 PMCID: PMC6779326 DOI: 10.1161/circulationaha.118.034497] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent developments in cancer therapeutics have improved outcomes but have also been associated with cardiovascular complications. Therapies harnessing the immune system have been associated with an immune-mediated myocardial injury described as myocarditis. Immune checkpoint inhibitors are one such therapy with an increasing number of case and cohort reports describing a clinical syndrome of immune checkpoint inhibitor–associated myocarditis. Although the full spectrum of immune checkpoint inhibitor–associated cardiovascular disease still needs to be fully defined, described cases of myocarditis range from syndromes with mild signs and symptoms to fatal events. These observations in the clinical setting stand in contrast to outcomes from randomized clinical trials in which myocarditis is a rare event that is investigator reported and lacking in a specific case definition. The complexities associated with diagnosis, as well as the heterogeneous clinical presentation of immune checkpoint inhibitor–associated myocarditis, have made ascertainment and identification of myocarditis with high specificity challenging in clinical trials and other data sets, limiting the ability to better understand the incidence, outcomes, and predictors of these rare events. Therefore, establishing a uniform definition of myocarditis for application in clinical trials of cancer immunotherapies will enable greater understanding of these events. We propose an operational definition of cancer therapy-associated myocarditis that may facilitate case ascertainment and report and therefore may enhance the understanding of the incidence, outcomes, and risk factors of this novel clinical syndrome.
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Affiliation(s)
- Marc P Bonaca
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin A Olenchock
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joe-Elie Salem
- Division of Cardiovascular Medicine, Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN.,Division of Oncology, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN.,UNICO APHP 6 Cardio-Oncology Program,Sorbonne Universite, INSERM Clinical Investigation Center Paris-Est Assistance Publique - Hopitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Stephen D Wiviott
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stephane Ederhy
- UNICO APHP 6 Cardio-Oncology Program,Service de cardiologie Hôpitaux Universitaires Est Parisien, Hôpital Saint Antoine, Assistance Publique–Hôpitaux de Paris, INSERM 856, Sorbonne-université, France
| | - Ariel Cohen
- UNICO APHP 6 Cardio-Oncology Program,Sorbonne-Université and INSERM 856, Hôpital Saint Antoine, Paris, France
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yves Allenbach
- Sorbonne University, AP-PH, Pitié Salpêtrière Hospital, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | - Laleh Amiri-Kordestani
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, London, United Kingdom
| | - Paaladinesh Thavendiranathan
- Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention and Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada
| | - Robert Padera
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Andrew Lichtman
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Peter P Liu
- Departments of Medicine and Cellular & Molecular Medicine, University of Ottawa Heart Institute, Ontario, Canada
| | - Douglas B Johnson
- Division of Oncology, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Javid Moslehi
- Division of Cardiovascular Medicine, Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN.,Division of Oncology, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN
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434
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Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, Ohya M, Suwa S, Takagi K, Nanasato M, Hata Y, Yagi M, Suematsu N, Yokomatsu T, Takamisawa I, Doi M, Noda T, Okayama H, Seino Y, Tada T, Sakamoto H, Hibi K, Abe M, Kawai K, Nakao K, Ando K, Tanabe K, Ikari Y, Hanaoka KI, Morino Y, Kozuma K, Kadota K, Furukawa Y, Nakagawa Y, Kimura T. Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial. JAMA 2019; 321:2414-2427. [PMID: 31237644 PMCID: PMC6593641 DOI: 10.1001/jama.2019.8145] [Citation(s) in RCA: 573] [Impact Index Per Article: 114.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Very short mandatory dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with a drug-eluting stent may be an attractive option. OBJECTIVE To test the hypothesis of noninferiority of 1 month of DAPT compared with standard 12 months of DAPT for a composite end point of cardiovascular and bleeding events. DESIGN, SETTING, AND PARTICIPANTS Multicenter, open-label, randomized clinical trial enrolling 3045 patients who underwent PCI at 90 hospitals in Japan from December 2015 through December 2017. Final 1-year clinical follow-up was completed in January 2019. INTERVENTIONS Patients were randomized either to 1 month of DAPT followed by clopidogrel monotherapy (n=1523) or to 12 months of DAPT with aspirin and clopidogrel (n=1522). MAIN OUTCOMES AND MEASURES The primary end point was a composite of cardiovascular death, myocardial infarction (MI), ischemic or hemorrhagic stroke, definite stent thrombosis, or major or minor bleeding at 12 months, with a relative noninferiority margin of 50%. The major secondary cardiovascular end point was a composite of cardiovascular death, MI, ischemic or hemorrhagic stroke, or definite stent thrombosis and the major secondary bleeding end point was major or minor bleeding. RESULTS Among 3045 patients randomized, 36 withdrew consent; of 3009 remaining, 2974 (99%) completed the trial. One-month DAPT was both noninferior and superior to 12-month DAPT for the primary end point, occurring in 2.36% with 1-month DAPT and 3.70% with 12-month DAPT (absolute difference, -1.34% [95% CI, -2.57% to -0.11%]; hazard ratio [HR], 0.64 [95% CI, 0.42-0.98]), meeting criteria for noninferiority (P < .001) and for superiority (P = .04). The major secondary cardiovascular end point occurred in 1.96% with 1-month DAPT and 2.51% with 12-month DAPT (absolute difference, -0.55% [95% CI, -1.62% to 0.52%]; HR, 0.79 [95% CI, 0.49-1.29]), meeting criteria for noninferiority (P = .005) but not for superiority (P = .34). The major secondary bleeding end point occurred in 0.41% with 1-month DAPT and 1.54% with 12-month DAPT (absolute difference, -1.13% [95% CI, -1.84% to -0.42%]; HR, 0.26 [95% CI, 0.11-0.64]; P = .004 for superiority). CONCLUSIONS AND RELEVANCE Among patients undergoing PCI, 1 month of DAPT followed by clopidogrel monotherapy, compared with 12 months of DAPT with aspirin and clopidogrel, resulted in a significantly lower rate of a composite of cardiovascular and bleeding events, meeting criteria for both noninferiority and superiority. These findings suggest that a shorter duration of DAPT may provide benefit, although given study limitations, additional research is needed in other populations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02619760.
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Affiliation(s)
- Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshiki Hata
- Department of Cardiology, Minamino Cardiovascular Hospital, Hachioji, Japan
| | - Masahiro Yagi
- Department of Cardiology, Sendai Cardiovascular Center, Sendai, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yoshitane Seino
- Department of Cardiology, Hoshi General Hospital, Koriyama, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Kengo Tanabe
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | | | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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435
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Ihdayhid AR, Norgaard BL, Gaur S, Leipsic J, Nerlekar N, Osawa K, Miyoshi T, Jensen JM, Kimura T, Shiomi H, Erglis A, Jegere S, Oldroyd KG, Botker HE, Seneviratne SK, Achenbach S, Ko BS. Prognostic Value and Risk Continuum of Noninvasive Fractional Flow Reserve Derived from Coronary CT Angiography. Radiology 2019; 292:343-351. [PMID: 31184558 DOI: 10.1148/radiol.2019182264] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Coronary CT angiography with noninvasive fractional flow reserve (FFR) predicts lesion-specific ischemia when compared with invasive FFR. The longer term prognostic value of CT-derived FFR (FFRCT) is unknown. Purpose To determine the prognostic value of FFRCT when compared with coronary CT angiography and describe the relationship of the numeric value of FFRCT with outcomes. Materials and Methods This prospective subanalysis of the NXT study (Clinicaltrials.gov: NCT01757678) evaluated participants suspected of having stable coronary artery disease who were referred for invasive angiography and who underwent FFR, coronary CT angiography, and FFRCT. The incidence of the composite primary end point of death, myocardial infarction, and any revascularization and the composite secondary end point of major adverse cardiac events (MACE: cardiac death, myocardial infarction, unplanned revascularization) were compared for an FFRCT of 0.8 or less versus stenosis of 50% or greater on coronary CT angiograms, with treating physicians blinded to the FFRCT result. Results Long-term outcomes were obtained in 206 individuals (age, 64 years ± 9.5), including 64% men. At median follow-up of 4.7 years, there were no cardiac deaths or myocardial infarctions in participants with normal FFRCT. The incidence of the primary end point was more frequent in participants with positive FFRCT compared with clinically significant stenosis at coronary CT angiography (73.4% [80 of 109] vs 48.7% [91 of 187], respectively; P < .001), with the majority of outcomes being planned revascularization. Corresponding hazard ratios (HRs) were 9.2 (95% confidence interval [CI]: 5.1, 17; P < .001) for FFRCT and 5.9 (95% CI: 1.5, 24; P = .01) for coronary CT angiography. FFRCT was a superior predictor compared with coronary CT angiography for primary end point (C-index FFRCT, 0.76 vs coronary CT angiography, 0.54; P < .001) and MACE (FFRCT, 0.71 vs coronary CT angiography, 0.52; P = .001). Frequency of MACE was higher in participants with positive FFRCT compared with coronary CT angiography (15.6% [17 of 109] vs 10.2% [19 of 187], respectively; P = .02), driven by unplanned revascularization. MACE HR was 5.5 (95% CI: 1.6, 19; P = .006) for FFRCT and 2.0 (95% CI: 0.3, 14; P = .46) for coronary CT angiography. Each 0.05-unit FFRCT reduction was independently associated with greater incidence of primary end point (HR, 1.7; 95% CI: 1.4, 1.9; P < .001) and MACE (HR, 1.4; 95% CI: 1.1, 1.8; P < .001). Conclusion In stable patients referred for invasive angiography, a CT-derived fractional flow reserve (FFRCT) value of 0.8 or less was a predictor of long-term outcomes driven by planned and unplanned revascularization and was superior to clinically significant stenosis on coronary CT angiograms. Additionally, the numeric value of FFRCT was an independent predictor of outcomes. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Dennie and Rubens in this issue.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Bjarne L Norgaard
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Sara Gaur
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Jonathan Leipsic
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Kazuhiro Osawa
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Toru Miyoshi
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Jesper M Jensen
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Takeshi Kimura
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Hiroki Shiomi
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Andrejs Erglis
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Sanda Jegere
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Keith G Oldroyd
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Hans Erik Botker
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Sujith K Seneviratne
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Stephan Achenbach
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
| | - Brian S Ko
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.)
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436
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Sabaté M. The MASTER trial: a new version of the oculostenotic reflex. EUROINTERVENTION 2019; 14:e1806-e1808. [PMID: 30956178 DOI: 10.4244/eijv14i18a316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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437
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Rozemeijer R, Wing Wong C, Leenders G, Timmers L, Koudstaal S, Rittersma SZ, Kraaijeveld A, Bots M, Doevendans P, Stella P, Voskuil M. Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients. Neth Heart J 2019; 27:321-329. [PMID: 30895527 PMCID: PMC6533324 DOI: 10.1007/s12471-019-1253-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p < 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p < 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, plog-rank < 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity. Electronic supplementary material The online version of this article (10.1007/s12471-019-1253-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Rozemeijer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C Wing Wong
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - S Z Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Bots
- Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - P Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - P Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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438
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Sambola A, Viana-Tejedor A, Bueno H, Antonio Barrabés, Delgado V, Jiménez P, Jorge Pérez P, Javier Noriega F, Vila M, Aboal J, Bouzas A, Brugaletta S, Durán A, Gómez de Diego JJ, Hernández F, López T, Lozano I, Núñez I, Ojeda S, Rosillo S, Sanchis J, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Sambola A, Vázquez R, Viana-Tejedor A. Comentarios al consenso ESC 2018 sobre la cuarta definición universal del infarto de miocardio. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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439
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Comments on the 2018 ESC Fourth Universal Definition of Myocardial. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 72:10-15. [PMID: 30580784 DOI: 10.1016/j.rec.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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440
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Ruel M, Falk V, Farkouh ME, Freemantle N, Gaudino MF, Glineur D, Cameron DE, Taggart DP. Myocardial Revascularization Trials. Circulation 2018; 138:2943-2951. [DOI: 10.1161/circulationaha.118.035970] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Canada (M.R., D.G.)
| | - Volkmar Falk
- German Heart Center, Charité Universitätsmedizin Berlin, Germany (V.F.)
| | - Michael E. Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Canada (M.E.F.)
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, UK (N.F.)
| | - Mario F. Gaudino
- New York Presbyterian Hospital, Weill Cornell Medicine, NY (M.F.G.)
| | - David Glineur
- University of Ottawa Heart Institute, University of Ottawa, Canada (M.R., D.G.)
| | - Duke E. Cameron
- Massachusetts General Hospital, Harvard Medical School, Boston (D.E.C.)
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441
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Tang Y, Qiao S, Su X, Chen Y, Jin Z, Chen H, Xu B, Kong X, Pang W, Liu Y, Yu Z, Li X, Li H, Zhao Y, Wang Y, Li W, Tian J, Guan C, Xu B, Gao R, Gao R, Qiao S, Gao R, Xu B, Tang Y, Qiao S, Su X, Zeng Y, Yang Q, Zhang J, Gao R, Qiao S, Xu B, Tang Y, Guan C, Tian J, Chen J, Wu Y, Yan H, Yang Y, Su X, Wang M, Wang J, Xu W, Chen Y, Jin Q, Jin Z, Yang D, Meng S, Chen H, Liang S, Yao D, Li D, Xu B, Song J, Dai Q, Wang K, Kang L, Wang L, Kong X, Wang H, Wang L, Pang W, Wan J, Liu Y, Wei L, He F, Xing X, Yu Z, Wang D, Jin R, Li X, Xue Y, Wang B, Li H, Wang M, Wang J. Drug-Coated Balloon Versus Drug-Eluting Stent for Small-Vessel Disease. JACC Cardiovasc Interv 2018; 11:2381-2392. [DOI: 10.1016/j.jcin.2018.09.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
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442
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Byrne RA, Colleran R, Kastrati A. Strengths and Limitations of Real World Data in Patients Treated With Coronary Stents. Circ Cardiovasc Interv 2018; 11:e007239. [PMID: 30354605 DOI: 10.1161/circinterventions.118.007239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (R.A.B., R.C., A.K.).,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (R.A.B., R.C., A.K.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (R.A.B., R.C., A.K.).,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Germany (R.A.B., A.K.)
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