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Tang G, Zheng N, Yang G, Li H, Ai H, Zhao Y, Sun F, Zhang H. Procedural Results and Long-Term Outcomes of Percutaneous Coronary Intervention for in-Stent Restenosis Chronic Total Occlusion Compared with de novo Chronic Total Occlusion. Int J Gen Med 2021; 14:5749-5758. [PMID: 34552350 PMCID: PMC8450285 DOI: 10.2147/ijgm.s328332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background In-stent restenosis (ISR) chronic total occlusion (CTO) represents a challenging subgroup for revascularization of CTO by percutaneous coronary intervention (PCI). There are limited data on the treatment and outcomes of PCI for ISR CTO. Objective We aimed to evaluate the procedural results and 2-year outcomes of PCI for ISR CTO compared with de novo CTO. Methods Patients undergoing attempted CTO PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 2-year major adverse cardiac events (MACE) in patients undergoing ISR CTO and those undergoing de novo CTO PCI. Results A total of 426 patients undergoing 484 consecutive CTO PCI (ISR CTO PCI, n=84; de novo CTO, n=400) were enrolled during the study period. Patients undergoing de novo CTO PCI had a significantly greater syntax score than those undergoing ISR CTO PCI [23.0 (17.5, 30.5) vs 21.5 (14.5, 27.0), p=0.039]. Technical (73.8% vs 79.0%, p=0.296) and procedural (73.8% vs 78.0, p=0.405) success rates, as well as the incidence of major procedural complications (1.2% vs 2.3%, p=0.842), were comparable between the two groups. After a median follow-up of 20 months, patients who underwent ISR CTO PCI had a significantly higher incidence of MACE (33.3% vs 10.3%, p<0.001), mainly attributed to the higher TVR rates (24.7% vs 7.6%, p<0.001). ISR CTO was the only independent predictor of MACE (hazard ratio, 4.124; 95% confidence interval, 1.951–8.717; p<0.001) during follow-up in patients who underwent CTO PCI. Conclusion ISR CTO PCI shows comparable technical and procedural success, as well as major procedural complications compared with de novo CTO PCI. However, patients who underwent ISR CTO PCI had a significantly worse prognosis than those who underwent de novo CTO PCI, in terms of MACE, driven by TVR. ISR CTO was the only independent predictor of MACE during the follow-up.
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Affiliation(s)
- Guodong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Naixin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Guojian Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Fucheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Huiping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
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7
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Wu EB, Brilakis ES, Mashayekhi K, Tsuchikane E, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Behnes M, Bhindi R, Boudou N, Boukhris M, Bozinovic NZ, Bryniarski L, Bufe A, Buller CE, Burke MN, Buttner A, Cardoso P, Carlino M, Chen JY, Christiansen EH, Colombo A, Croce K, de Los Santos FD, de Martini T, Dens J, di Mario C, Dou K, Egred M, Elbarouni B, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Gasparini G, Ge J, Ge L, Goel PK, Goktekin O, Gonzalo N, Grancini L, Hall A, Hanna Quesada FL, Hanratty C, Harb S, Harding SA, Hatem R, Henriques JPS, Hildick-Smith D, Hill JM, Hoye A, Jaber W, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Khatri J, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Lamelas PM, Lee SW, Lefevre T, Leung R, Li Y, Li Y, Lim ST, Lo S, Lombardi W, Maran A, McEntegart M, Moses J, Munawar M, Navarro A, Ngo HM, Nicholson W, Oksnes A, Olivecrona GK, Padilla L, Patel M, Pershad A, Postu M, Qian J, Quadros A, Rafeh NA, Råmunddal T, Prakasa Rao VS, Reifart N, Riley RF, Rinfret S, Saghatelyan M, Sianos G, Smith E, Spaedy A, Spratt J, Stone G, Strange JW, Tammam KO, Thompson CA, Toma A, Tremmel JA, Trinidad RS, Ungi I, Vo M, Vu VH, Walsh S, Werner G, Wojcik J, Wollmuth J, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:840-853. [PMID: 34412818 DOI: 10.1016/j.jacc.2021.05.055] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | - Mario Araya
- Clinica Alemana, Hospital Militar de Santiago, Santiago, Chile
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Ravinay Bhindi
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Marouane Boukhris
- Cardiology Department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Alexander Bufe
- Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
| | - Christopher E Buller
- Teleflex, Markham, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Pedro Cardoso
- Santa Maria University Hospital, Lisbon Academic Medical Centre and Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Ji-Yan Chen
- Guangdong General Hospital, Guangdong, China
| | | | - Antonio Colombo
- Cardiology, Humanitas University, Humanitas IRCCS, Rozzano, Milan, Italy
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Carlo di Mario
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Kefei Dou
- Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mohaned Egred
- Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - Basem Elbarouni
- St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Javier Escaned
- Hospital Clinico San Carlos, IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Sergey Furkalo
- National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Alfredo R Galassi
- Cardiovascular Medicine Department of PROMISE University of Palermo, Palermo, Italy
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Allison Hall
- Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | - Stefan Harb
- Medical University of Graz, University Heart Center, Graz, Austria
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Raja Hatem
- Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Angela Hoye
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Risto Jussila
- Interventional Cardiology, Helsinki Heart Hospital, Helsinki, Finland
| | - Artis Kalnins
- Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia
| | | | - David E Kandzari
- Piedmont Heart Institute and Cardiovascular Services, Atlanta, Georgia, USA
| | - Hsien-Li Kao
- Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hussien Heshmat Kassem
- Kasr Alainy Medical School, Cairo University, Cairo, Egypt, and Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates
| | | | - Paul Knaapen
- Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr. L.H. Hiranandani Hospital, Mumbai, India
| | - Pablo Manuel Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Prive Jacques Cartier, Massy, France
| | - Raymond Leung
- C.K. Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Yu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia
| | | | - Anbukarasi Maran
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | | | - Jeffrey Moses
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Muhammad Munawar
- Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, and Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia
| | - Andres Navarro
- Hospital de los Valles, Hospital de Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador
| | - Hung M Ngo
- Choray University Hospital, Hochiminh City, Vietnam
| | | | - Anja Oksnes
- Heart Department, Haukeland University Hospital, Bergen, Norway
| | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu," Bucharest, Romania
| | - Jie Qian
- Beijing Fuwai Hospital, Beijing, China
| | - Alexandre Quadros
- Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon, and North Oaks Healthcare System, Hammond, Louisiana, USA
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
| | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | | | | | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - James Spratt
- St. George's University Hospital NHS Foundation Trust, London, UK
| | - Gregg Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julian W Strange
- Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK
| | - Khalid O Tammam
- Department at the International Medical Center, Jeddah, Saudi Arabia
| | | | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Imre Ungi
- University of Szeged, Department of Invasive Cardiology, Szeged, Hungary
| | - Minh Vo
- Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Vu Hoang Vu
- Heart Center University Medical Center, Ho Chi Minh City, Vietnam
| | - Simon Walsh
- Belfast Health and Social Care Trust, Belfast, UK
| | - Gerald Werner
- Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany
| | - Jaroslaw Wojcik
- Hospital of Invasive Cardiology IKARDIA, Nałęczów/Lublin, Poland
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Portland, Oregon, USA
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, Shanghai, China
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8
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Vemmou E, Quadros AS, Dens JA, Rafeh NA, Agostoni P, Alaswad K, Avran A, Belli KC, Carlino M, Choi JW, El-Guindy A, Jaffer FA, Karmpaliotis D, Khatri JJ, Khelimskii D, Knaapen P, La Manna A, Krestyaninov O, Lamelas P, Ojeda S, Padilla L, Pan M, Piccaro de Oliveira P, Rinfret S, Spratt JC, Tanabe M, Walsh S, Nikolakopoulos I, Karacsonyi J, Rangan BV, Brilakis ES, Azzalini L. In-Stent CTO Percutaneous Coronary Intervention: Individual Patient Data Pooled Analysis of 4 Multicenter Registries. JACC Cardiovasc Interv 2021; 14:1308-1319. [PMID: 34052151 DOI: 10.1016/j.jcin.2021.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The authors sought to examine the outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusions (CTOs). BACKGROUND The outcomes of PCI for ISR CTOs have received limited study. METHODS The authors examined the clinical and angiographic characteristics and procedural outcomes of 11,961 CTO PCIs performed in 11,728 patients at 107 centers in Europe, North America, Latin America, and Asia between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events (MACE) included death, myocardial infarction, stroke, and tamponade. Long-term MACE were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. RESULTS ISR represented 15% of the CTOs (n = 1,755). Patients with ISR CTOs had higher prevalence of diabetes (44% vs. 38%; p < 0.0001) and prior coronary artery bypass graft surgery (27% vs. 24%; p = 0.03). Mean J-CTO (Multicenter CTO Registry in Japan) score was 2.32 ± 1.27 in the ISR group and 2.22 ± 1.27 in the de novo group (p = 0.01). Technical (85% vs. 85%; p = 0.75) and procedural (84% vs. 84%; p = 0.82) success was similar for ISR and de novo CTOs, as was the incidence of in-hospital MACE (1.7% vs. 2.2%; p = 0.25). Antegrade wiring was the most common successful strategy, in 70% of ISR and 60% of de novo CTOs, followed by retrograde crossing (16% vs. 23%) and antegrade dissection and re-entry (15% vs. 16%; p < 0.0001). At 12 months, patients with ISR CTOs had a higher incidence of MACE (hazard ratio: 1.31; 95% confidence interval: 1.01 to 1.70; p = 0.04). CONCLUSIONS ISR CTOs represent 15% of all CTO PCIs and can be recanalized with similar success and in-hospital MACE as de novo CTOs.
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Affiliation(s)
- Evangelia Vemmou
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Joseph A Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | | | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-Nancy, France
| | - Karlyse C Belli
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauro Carlino
- San Raffaele Hospital, University of Medicine of Milan, Milan, Italy
| | - James W Choi
- Baylor Scott and White, Heart and Vascular Hospital, Dallas, Texas, USA
| | | | | | | | | | - Dmitrii Khelimskii
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Oleg Krestyaninov
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Soledad Ojeda
- Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Pan
- Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | | | | | - James C Spratt
- St. George's University Healthcare NHS Trust, London, United Kingdom
| | - Masaki Tanabe
- Department of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
| | | | | | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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