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Barone-Rochette G. The hyperdeliverability of the latest evolution of drug-eluting stents should not cause any steps to be omitted during percutaneous coronary intervention. Arch Cardiovasc Dis 2021; 114:609-611. [PMID: 34548265 DOI: 10.1016/j.acvd.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gilles Barone-Rochette
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, LRB, 38000 Grenoble, France; Department of Cardiology, CHU Grenoble Alpes, 38000 Grenoble, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, 75018 Paris, France.
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2
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Dangas G, Baber U, Sharma S, Giustino G, Mehta S, Cohen DJ, Angiolillo DJ, Sartori S, Chandiramani R, Briguori C, Dudek D, Escaned J, Huber K, Collier T, Kornowski R, Kunadian V, Kaul U, Oldroyd K, Sardella G, Shlofmitz R, Witzenbichler B, Ya-Ling H, Pocock S, Gibson CM, Mehran R. Ticagrelor With or Without Aspirin After Complex PCI. J Am Coll Cardiol 2020; 75:2414-2424. [DOI: 10.1016/j.jacc.2020.03.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
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3
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Buiten RA, Ploumen EH, Zocca P, Doggen CJM, van Houwelingen KG, Danse PW, Schotborgh CE, Stoel MG, Scholte M, Linssen GCM, de Man FHAF, von Birgelen C. Three contemporary thin-strut drug-eluting stents implanted in severely calcified coronary lesions of participants in a randomized all-comers trial. Catheter Cardiovasc Interv 2020; 96:E508-E515. [PMID: 32237060 PMCID: PMC7687234 DOI: 10.1002/ccd.28886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective was to assess the 2-year clinical performance of three drug-eluting stents in all-comer patients with severely calcified coronary lesions. BACKGROUND Severe lesion calcification increases cardiovascular event risk after coronary stenting, but there is a lack of data on the clinical outcome of all-comers with severely calcified lesions who were treated with more recently introduced drug-eluting stents. METHODS The BIO-RESORT trial (clinicaltrials.gov: NCT01674803) randomly assigned 3,514 all-comer patients to biodegradable polymer Synergy everolimus-eluting stents (EES) or Orsiro sirolimus-eluting stents (SES), versus durable polymer Resolute Integrity zotarolimus-eluting stents (ZES). In a post hoc analysis, we assessed 783 patients (22.3%) with at least one severely calcified target lesion. RESULTS At 2-year follow-up (available in 99% of patients), the main composite endpoint target vessel failure occurred in 19/252 (7.6%) of the EES and in 33/265 (12.6%) of the ZES-treated patients (p = .07). Target vessel failure occurred in 24/266 (9.1%) of the SES-treated patients (vs. ZES: p = .21). There was a difference in target vessel revascularization, which was required in EES in 6/252 (2.4%) patients and in ZES in 20/265 (7.7%) patients (p = .01); the target vessel revascularization rate in SES was 9/266 (3.4%, vs. ZES: p = .04). Multivariate analysis showed that implantation of EES, but not SES, was independently associated with lower target vessel revascularization rates than in ZES. CONCLUSIONS In BIO-RESORT participants with severely calcified target lesions, treatment with EES was associated with a lower 2-year target vessel revascularization rate than treatment with ZES.
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Affiliation(s)
- Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Peter W Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Martin G Stoel
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Martijn Scholte
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands
| | - Frits H A F de Man
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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4
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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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5
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6
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Lu H, Bekker RJ, Grundeken MJ, Woudstra P, Wykrzykowska JJ, Tijssen JGP, de Winter RJ, Koch KT. Five-year clinical follow-up of the STENTYS self-apposing stent in complex coronary anatomy: a single-centre experience with report of specific angiographic indications. Neth Heart J 2018; 26:263-271. [PMID: 29654515 PMCID: PMC5910317 DOI: 10.1007/s12471-018-1111-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives We sought to investigate angiographic indications for the use of the STENTYS technique and evaluated the long-term safety and clinical efficacy of the stent. Background Coronary lesions involving complex anatomy, including aneurysmatic, ectatic, or tapered vessel segments often carry a substantial risk of stent malapposition. The self-apposing stent technique may reduce the risk of stent malapposition and therefore improve clinical outcomes. Methods A total of 120 consecutive patients treated with the STENTYS stent were included (drug-eluting stent (DES) n = 101, bare-metal stent (BMS) n = 19). All lesions were scored for angiographic indications for the STENTYS stent, including aneurysms, ectasias, tapering, absolute diameters, bifurcation lesions, and saphenous vein grafts. Off-line quantitative coronary angiography analyses were performed pre-procedure and post-procedure. Five years follow-up was obtained including cardiac death, target vessel myocardial infarction (TV-MI), target vessel revascularisation, stent thrombosis, and the composite endpoint target vessel failure (cardiac death, TV-MI and target vessel revascularisation). Results Angiographic indications for STENTYS use were aneurysm (30%), ectasia (19%), tapering (27%), bifurcation lesions (8%), and saphenous vein graft lesions (16%) and absolute diameters (22%). Mean maximal diameter was 4.51 ± 0.99 mm. At 5‑year follow-up target vessel failure rates were 24.1% in the total cohort (DES 22.8% vs. BMS 33%, p = 0.26). Definite stent thrombosis rate was 3.8% at 5‑year follow-up in this cohort with complex and high-risk lesions (DES 4.5% vs. BMS 0%, p = 0.39). Conclusions Angiographic indications for the use of the self-apposing stent were complex lesions with atypical coronary anatomy. Our data showed reasonable stent thrombosis rates at 5‑year follow-up, considering the high-risk lesion characteristics. Electronic supplementary material The online version of this article (10.1007/s12471-018-1111-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H Lu
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Bekker
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M J Grundeken
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P Woudstra
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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7
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Bechiri MY, Souteyrand G, Lefèvre T, Trouillet C, Rangé G, Cayla G, Dérimay F, Mangin L, Meneveau N, Caussin C, Motreff P, Amabile N. Characteristics of stent thrombosis in bifurcation lesions analysed by optical coherence tomography. EUROINTERVENTION 2018; 13:e2174-e2181. [DOI: 10.4244/eij-d-17-00794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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8
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Redfors B, Généreux P, Witzenbichler B, Maehara A, Weisz G, McAndrew T, Mehran R, Kirtane AJ, Stone GW. Percutaneous coronary intervention of lesions with in-stent restenosis: A report from the ADAPT-DES study. Am Heart J 2018; 197:142-149. [PMID: 29447774 DOI: 10.1016/j.ahj.2017.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. METHODS Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. RESULTS Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8%) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95% CI 1.68-2.27; P<.001) and stent thrombosis (adjusted HR 1.95; 95% CI 1.08-3.51; P=.027) but not bleeding (adjusted HR 0.94; 95% CI 0.73-1.21; P=.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction=.81). CONCLUSIONS ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.
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Affiliation(s)
- Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
| | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Giora Weisz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Montefiore Medical Center, Bronx, NY
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Roxana Mehran
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, Amico F, Marco V, Ramazzotti V, Di Giorgio A, Di Vito L, Boi A, Contarini M, Castriota F, Mintz GS, Prati F. Role of residual acute stent malapposition in percutaneous coronary interventions. Catheter Cardiovasc Interv 2017; 90:566-575. [DOI: 10.1002/ccd.26974] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Enrico Romagnoli
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | - Laura Gatto
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
| | | | | | | | | | | | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | | | | | | | | | | | - Fausto Castriota
- GVM Care and Research, E. S. Health Science Foundation; Cotignola Italy
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York, New York
| | - Francesco Prati
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
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10
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Shan P, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Généreux P, Crowley A, Kirtane AJ, Stone GW, Maehara A. Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy. Int J Cardiol 2017; 248:97-102. [PMID: 28818353 DOI: 10.1016/j.ijcard.2017.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/13/2017] [Accepted: 08/09/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. METHODS ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV%=dense calcium/plaque volume×100). RESULTS Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p=0.01), but acceptable range, and similar stent expansion (73.8±16.8% vs. 74.0±19.2% vs. 72.4±17.3%, p=0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). CONCLUSIONS Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.
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Affiliation(s)
- Peiren Shan
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China; Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, NY, USA; Montefiore Medical Center, Bronx, NY, USA
| | - Thomas D Stuckey
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - Bruce R Brodie
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
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11
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Nuñez López VF, Cohen MG. The elusive prediction of stent thrombosis. Catheter Cardiovasc Interv 2017; 89:35-36. [DOI: 10.1002/ccd.26897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mauricio G. Cohen
- Cardiovascular Division, Department of Medicine; University of Miami Miller School of Medicine; Miami Florida
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12
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Wang B, Mintz GS, Witzenbichler B, Souza CF, Metzger DC, Rinaldi MJ, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Matsumura M, Yamamoto MH, Parvataneni R, Kirtane AJ, Stone GW, Maehara A. Predictors and Long-Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) Intravascular Ultrasound Substudy. J Am Heart Assoc 2016; 5:e004438. [PMID: 28007741 PMCID: PMC5210413 DOI: 10.1161/jaha.116.004438] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of acute stent malapposition (ASM) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long-term clinical outcomes of ASM. METHODS AND RESULTS ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug-eluting stents. In a prespecified intravascular ultrasound-guided substudy, 2072 patients with 2446 culprit lesions had post-percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound-guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug-eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in-stent lumen areas, larger stent areas, and larger in-stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2-year follow-up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2-year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model. CONCLUSIONS In patients treated with intravascular ultrasound-guided drug-eluting stents implantation, ASM was not associated with adverse clinical events during long-term follow-up including, but not limited to, stent thrombosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.
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Affiliation(s)
- Bin Wang
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shenyang Northern Hospital, Shenyang, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | | | | | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Thomas D Stuckey
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | - Bruce R Brodie
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | | | - Myong-Hwa Yamamoto
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | | | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
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13
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Généreux P, Bettinger N, Redfors B, Lee AC, Kim CY, Lee MS, Shlofmitz RA, Moses JW, Stone GW, Chambers JW. Two-year outcomes after treatment of severely calcified coronary lesions with the orbital atherectomy system and the impact of stent types: Insight from the ORBIT II trial. Catheter Cardiovasc Interv 2016; 88:369-77. [DOI: 10.1002/ccd.26554] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
- Hôpital Du Sacré-Coeur De Montréal; Université De Montréal; Montréal Québec Canada
| | - Nicolas Bettinger
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Björn Redfors
- Cardiovascular Research Foundation; New York New York
- Sahlgrenska University Hospital; Gothenburg Sweden
| | - Arthur C. Lee
- The Cardiac & Vascular Institute; Gainesville Florida
| | | | | | | | - Jeffrey W. Moses
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Gregg W. Stone
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Jeff W. Chambers
- Mercy Hospital; Metropolitan Heart and Vascular Institute; Minneapolis Minnesota
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