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Pandit N, Rahatekar P, Rekwal L, Kuber D, Nath RK, Aggarwal P. Target Vessel Versus Complete Revascularization in Non-ST Elevation Myocardial Infarction Without Cardiogenic Shock. Cureus 2022; 14:e23139. [PMID: 35444901 PMCID: PMC9009965 DOI: 10.7759/cureus.23139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The role of complete revascularization (CR) vs target vessel revascularization (TVR) in non-ST-elevation myocardial infarction (NSTEMI) in patients without cardiogenic shock is still not established. In this study, we compared outcomes at one and six months among patients with NSTEMI with multivessel disease (MVD) undergoing CR vs TVR. Methods It was a prospective, observational study carried out among 60 NSTEMI patients with MVD (30 undergoing TVR and 30 CR) from October 2018 to November 2019. They were assessed at one and six months for primary and secondary outcomes. Results The mean age of the patients was 56.13 ± 9.23 years and both the groups were well matched with respect to age, gender, risk factors, and comorbidities. In the majority of patients, the target vessel was left anterior descending (LAD) followed by right coronary artery (RCA) and left circumflex (LCX) in both groups. The primary outcomes of death from any cause, non-fatal myocardial infarction, and the need for revascularization of the ischemia-driven vessel showed no significant difference at one and six months follow-up between the CR and TVR groups. However, the secondary outcomes of heart failure hospitalizations and angina episodes were significantly more in the TVR group than CR group at one month (6 vs 1, P=0.044), (8 vs 2, P=0.038) and six months (8 vs 2, P=0.038), (9 vs 2, P=0.02), respectively. Conclusion CR was associated with no difference in death from all-cause or future revascularization but significantly lesser secondary outcomes of heart failure hospitalizations and angina episodes as compared to TVR in NSTEMI without cardiogenic shock.
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2
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Goel P, Sahu A, Layek M, Khanna R, Mishra P. Impact of completeness of revascularisation on long-term outcomes in patients with multivessel disease undergoing PCI: CR versus IR outcomes in multivessel CAD. ASIAINTERVENTION 2021; 7:35-44. [PMID: 34913000 PMCID: PMC8670570 DOI: 10.4244/aij-d-21-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/26/2021] [Indexed: 06/14/2023]
Abstract
AIMS We aimed to study long-term clinical outcomes in patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI) over the last 10 years with respect to the completeness of revascularisation at a tertiary care hospital. METHODS AND RESULTS A total of 2,960 consecutive MVD patients taken for PCI between 2008 to 2017 were enrolled in the study with baseline demographic, procedural, and follow-up details retrieved from custom-made departmental software. Of those, 2,598 patients with follow-up details constituted the study cohort. Complete revascularisation (CR) was achieved in 1,854 (71.4%) and incomplete revascularisation (IR) in 744 (28.6%) patients. Propensity matching was performed and 740 matched pairs identified in the two groups. The primary endpoint was survival free of any major adverse cardiovascular events (MACE) with each individual MACE event being a secondary endpoint. IR occurred more often in patients with acute coronary syndrome (64.1% vs 58.3%, p=0.003), complex lesion intervention (40.7% vs 29.6%, p<0.001) and in those with mean stent length ≥38 mm per vessel intervened (21.0% vs 13.5%, p<0.001). Median follow-up was 54 months (interquartile range: 31-84 months). After propensity matching, CR resulted in a better survival free of all adverse events, i.e., 86.4% vs 81.1% (HR 1.52, CI: 1.21-2.02; p<0.01). Individual MACE endpoints were, however, not statistically different between the groups. CONCLUSIONS In MVD patients undergoing PCI, CR results in better survival free of all adverse events including all-cause mortality, non-fatal MI, repeat revascularisation and recurrent angina.
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Affiliation(s)
- Pravin Goel
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. E-mail:
| | - Ankit Sahu
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Manas Layek
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi PGIMS, Lucknow, India
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3
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Iqbal MB, Moore PT, Nadra IJ, Robinson SD, Fretz E, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Webb J, Sheth T, Jolly SS, Mehta SR, Sathananthan J, Wood DA, Della Siega A. Complete revascularization in stable multivessel coronary artery disease: A real world analysis from the British Columbia Cardiac Registry. Catheter Cardiovasc Interv 2021; 99:627-638. [PMID: 33660326 DOI: 10.1002/ccd.29564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND More than half of patients undergoing percutaneous coronary intervention (PCI) have multivessel disease (MVD). The prognostic significance of PCI in stable patients has recently been debated, but little data exists about the potential benefit of complete revascularization (CR) in stable MVD. We investigated the prognostic benefit of CR in patients undergoing PCI for stable disease. METHODS We compared CR versus incomplete revascularization (IR) in 8,436 patients with MVD. The primary outcome was all-cause mortality at 5 years. RESULTS A total of 1,399 patients (17%) underwent CR during the index PCI procedure for stable disease. CR was associated with lower mortality (6.2 vs. 10.7%, p < .001) and lower repeat revascularization at 5 years (12.7 vs. 18.4%, p < .001). Multivariable-adjusted analyses indicated that CR was associated with lower mortality (HR = 0.73, 95% CI: 0.58-0.91, p = .005) and repeat revascularization at 5 years (HR = 0.78, 95% CI: 0.66-0.93, p = .005). These findings were also confirmed in propensity-matched cohorts. Subgroup analyses indicated that CR conferred survival in older patients, male patients, absence of renal disease, greater angina (CCS Class III-IV) and heart failure (NYHA Class III-IV) symptoms, and greater burden of coronary disease. In sensitivity analyses where patients with subsequent repeat revascularization events were excluded, CR remained a strong predictor for lower mortality (HR = 0.69, 95% CI: 0.54-0.89, p = .004). CONCLUSIONS In this study of stable patients with MVD, CR was an independent predictor of long-term survival. This benefit was specifically seen in higher risk patient groups and indicates that CR may benefit selected stable patients with MVD.
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Affiliation(s)
- M Bilal Iqbal
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter T Moore
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Imad J Nadra
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Simon D Robinson
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Fretz
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Lillian Ding
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Anthony Fung
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Eve Aymong
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Albert W Chan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Steven Hodge
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - John Webb
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tej Sheth
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Li T, Jia S, Liu Y, Yao Y, Song Y, Tang X, Zhao X, Gao R, Yang Y, Xu B, Gao Z, Yuan J. Long-Term Outcomes of Single-Vessel Percutaneous Coronary Intervention on Culprit Vessel vs. Multivessel Percutaneous Coronary Intervention in Non-ST-Segment Elevation Acute Coronary Syndrome Patients With Multivessel Coronary Artery Disease. Circ J 2021; 85:185-193. [PMID: 33431719 DOI: 10.1253/circj.cj-20-0369] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal percutaneous coronary intervention (PCI) strategy for multivessel lesions in the setting of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains controversial. This study sought to compare long-term prognosis between single-vessel PCI (SV-PCI) and multivessel PCI (MV-PCI) in patients with multivessel coronary artery disease (MV-CAD) presenting with NSTE-ACS in a real-world population.Methods and Results:NSTE-ACS patients with MV-CAD undergoing PCI in Fuwai Hospital in 2013 were consecutively enrolled. SV-PCI was defined as targeting only the culprit vessel, whereas MV-PCI was defined as treating ≥1 coronary artery(s) in addition to the culprit vessel at the index procedure. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) at 2 years, consisting of all-cause death, cardiac death, myocardial infarction, unplanned revascularization, or stroke. A total of 3,338 patients were included. Both SV-PCI and MV-PCI were performed in 2,259 patients and 1,079 patients, respectively. During a median follow up of 2.1 years, the MACCE rates and adjusted risk were not significantly different between the SV-PCI and MV-PCI groups (13.1% vs. 14.0%, P=0.735; adjusted HR=0.967, 95% CI: 0.792-1.180). Similar results were observed in propensity-score matching and inverse probability of treatment weighting analyses. Subgroup analysis revealed a consistent effect on 2-year MACCE across different subgroups. CONCLUSIONS In NSTE-ACS patients with MV-CAD, MV-PCI is not superior to SV-PCI in terms of long-term MACCE.
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Affiliation(s)
- Tianyu Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Sida Jia
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yue Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaofang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xueyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jinqing Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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5
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Ying S, Li X. Renal insufficiency and outcomes in patients with acute coronary syndrome. Int J Cardiol 2020; 327:36. [PMID: 33259873 DOI: 10.1016/j.ijcard.2020.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Shishi Ying
- Emergency Department, YiWu Central Hospital, Zhejing 322000, China
| | - Xiaofei Li
- Department of Infectious Diseases, YiWu Central Hospital, Zhejiang 322000, China..
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Baumann AAW, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Ther Adv Chronic Dis 2020; 11:2040622320938527. [PMID: 32655848 PMCID: PMC7331770 DOI: 10.1177/2040622320938527] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.
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Affiliation(s)
- Angus A. W. Baumann
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Aashka Mishra
- Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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7
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Siebert VR, Borgaonkar S, Jia X, Nguyen HL, Birnbaum Y, Lakkis NM, Alam M. Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial Revascularization for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes. Am J Cardiol 2019; 124:1501-1511. [PMID: 31575424 DOI: 10.1016/j.amjcard.2019.07.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/19/2022]
Abstract
We present a systematic review and meta-analysis comparing efficacy and safety outcomes between single procedure multivessel revascularization (MVR) and culprit vessel only revascularization in patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS), and multivessel disease is common. There is no consensus on the most efficacious single procedure revascularization strategy for patients undergoing percutaneous coronary intervention not meeting coronary artery bypass grafting criteria. Studies in PubMed and EMBASE databases were systematically reviewed, and 15 studies met criteria for inclusion in the meta-analysis. Baseline characteristics between the groups were similar. A random effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins I2 tests. For short-term outcomes, patients who underwent MVR had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to 1.29; p = 0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; p = 0.05), but lower rates of urgent or emergent coronary artery bypass grafting (OR 0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR patients had less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93; p = 0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; p = 0.03), and repeat revascularization, (OR 0.62; 95% CI 0.42 to 0.90; p = 0.01). MVR following NSTE-ACS was associated with higher short-term risk, but long-term benefit. In conclusion, these results support the use of single procedure multivessel revascularization for NSTE-ACS patients who are suitable candidates at the time of percutaneous coronary intervention.
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Affiliation(s)
| | - Sanket Borgaonkar
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Xiaoming Jia
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hong Loan Nguyen
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Yochai Birnbaum
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Nasser M Lakkis
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mahboob Alam
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
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8
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Rathod KS, Koganti S, Jain AK, Astroulakis Z, Lim P, Rakhit R, Kalra SS, Dalby MC, O'Mahony C, Malik IS, Knight CJ, Mathur A, Redwood S, Sirker A, MacCarthy PA, Smith EJ, Wragg A, Jones DA. Complete Versus Culprit-Only Lesion Intervention in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2019; 72:1989-1999. [PMID: 30336821 DOI: 10.1016/j.jacc.2018.07.089] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/29/2018] [Accepted: 07/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND A large proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) present with multivessel disease (MVD). There is uncertainty in the role of complete coronary revascularization in this group of patients. OBJECTIVES The aim of this study was to investigate the outcomes of complete revascularization compared with culprit vessel-only intervention in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI) for NSTEMI. METHODS The authors undertook an observational cohort study of 37,491 NSTEMI patients treated between 2005 and 2015 at the 8 heart attack centers in London. Clinical details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. A total of 21,857 patients (58.3%) presented with NSTEMI and MVD. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2 to 5.8 years). RESULTS A total of 11,737 (53.7%) patients underwent single-stage complete revascularization during PCI for NSTEMI, rates that significantly increased during the study period (p = 0.006). Those patients undergoing complete revascularization were older and more likely to be male, diabetic, have renal disease and a history of previous myocardial infarction/revascularization compared with the culprit-only revascularization group. Although crude, in-hospital major adverse cardiac event rates were similar (5.2% vs. 4.8%; p = 0.462) between the 2 groups. Kaplan-Meier analysis demonstrated significant differences in mortality rates between the 2 groups (22.5% complete revascularization vs. 25.9% culprit vessel intervention; p = 0.0005) during the follow-up period. After multivariate Cox analysis (hazard ratio: 0.90; 95% confidence interval: 0.85 to 0.97) and the use of propensity matching (hazard ratio: 0.89; 95% confidence interval: 0.76 to 0.98) complete revascularization was associated with reduced mortality. CONCLUSIONS In NSTEMI patients with MVD, despite higher initial (in-hospital) mortality rates, single-stage complete coronary revascularization appears to be superior to culprit-only vessel PCI in terms of long-term mortality rates. This supports the need for further randomized study to confirm these findings.
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Affiliation(s)
| | | | - Ajay K Jain
- Barts Health NHS Trust, London, United Kingdom
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom
| | - Roby Rakhit
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, London, United Kingdom
| | | | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom
| | | | | | - Simon Redwood
- St. Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, London, United Kingdom
| | | | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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9
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Hsieh MJ, Chen CC, Lee CH, Wang CY, Chang SH, Chen DY, Yang CH, Tsai ML, Yeh JK, Ho MY, Hsieh IC. Complete and incomplete revascularization in non-ST segment myocardial infarction with multivessel disease: long-term outcomes of first- and second-generation drug-eluting stents. Heart Vessels 2018; 34:251-258. [PMID: 30159655 DOI: 10.1007/s00380-018-1252-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/24/2018] [Indexed: 12/17/2022]
Abstract
The therapeutic effects of reperfusion strategies with complete revascularization (CR) or incomplete revascularization (IR) in non-ST segment myocardial infarction (NSTEMI) patients with multivessel disease (MVD) are controversial. In such patients, whether utilization of different generations of drug-eluting stents (DES) for IR or CR affect long-term major adverse cardiovascular events (MACE) is unknown. This study included 702 NSTEMI patients with MVD who received first-generation (1G) or second-generation (2G) DES. In multivariable analysis, chronic kidney disease, chronic total, 1G DES and IR were independent predictors of long-term MACE. In patients receiving 1G DES, no significant differences of MACE were observed between the IR and CR groups (39.1% vs. 36.2%, p = 0.854). However, in patients receiving 2G DES, significantly fewer MACE were observed in the CR group than in the IR group (3.7% vs. 10.2%, p = 0.002). Compared with patients receiving 1G DES for IR, those receiving 2G DES for IR and CR exhibited significantly lower risk of MACE (59% and 83% lower, respectively). CR could not provide clinical benefits over IR in NSTEMI patients with MVD receiving 1G DES. However, in patients receiving 2G DES, compared with IR, CR was associated with a lower risk of long-term MACE, which was mainly caused by low rates of non-TLR and any revascularization.
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Affiliation(s)
- Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Chao-Yung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Ming-Lung Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Jih-Kai Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - Ming-Yun Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
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10
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Early and long-term outcomes of complete revascularization with percutaneous coronary intervention in patients with multivessel coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:32-41. [PMID: 29743902 PMCID: PMC5939543 DOI: 10.5114/aic.2018.74353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The clinical significance of complete revascularization with percutaneous coronary intervention (CR-PCI) in patients with non-ST-segment acute coronary syndrome (NSTE-ACS) remains uncertain. Aim To evaluate the impact of CR-PCI during index hospitalization on short and long-term incidence of death and composite endpoint among patients with multivessel coronary artery disease (CAD) presenting with NSTE-ACS. Material and methods We analyzed consecutive data of 1,592 patients with multivessel CAD from 2006 to 2014. Patients with prior coronary artery bypass grafting (CABG), cardiogenic shock, treated conservatively or with CABG and scheduled for planned CABG or PCI after discharge were excluded. The 30-day and 12-month composite endpoint was defined as all-cause death, nonfatal myocardial infarction (MI) or ACS-driven unplanned revascularization. Six hundred and ninety-five patients were divided into 2 groups: CR-PCI (n = 137) (CR-PCI during index hospitalization) and IR-PCI (n = 558) (incomplete revascularization). Results Incidence of composite endpoint (3.6% vs. 10.2%; HR = 0.31; 95% CI: 0.12–0.87; p = 0.025) and death (0.7% vs. 5.7%, HR = 0.11; 95% CI: 0.02–0.93; p = 0.043) at 30 days was lower in CR-PCI than in IR-PCI. At 12-month follow-up occurrence of composite endpoint was lower in CR-PCI (14.7%) than in IR-PCI (27.4%, p = 0.0037). Multivariate analysis confirmed that CR PCI was associated with a reduction in 12-month composite endpoint (HR = 0.56; 95% CI: 0.31–0.99; p = 0.046). The 12-month mortality was lower in CR-PCI (7.4% vs. 14.8%; p = 0.031), but it was not confirmed in the multivariate analysis. Conclusions In patients with multivessel CAD and NSTE-ACS, CR-PCI during index hospitalization was independently associated with improved early and long-term prognosis without significant differences in periprocedural outcomes in comparison to IR-PCI.
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Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Campos Soares F, Baptista J, Morais J. Progressão ultrarrápida de doença coronária ou placa instável não detetada? Rev Port Cardiol 2018; 37:259-264. [DOI: 10.1016/j.repc.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/28/2022] Open
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Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Soares FC, Baptista J, Morais J. Ultra-rapid progression of coronary artery disease or undiagnosed unstable plaque? A brief review from a case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Correia C, Galvão Braga C, Martins J, Arantes C, Abreu G, Quina C, Salgado A, Álvares Pereira M, Costa J, Marques J. Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease. Rev Port Cardiol 2018; 37:143-154. [PMID: 29486987 DOI: 10.1016/j.repc.2017.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/09/2017] [Accepted: 05/03/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD). OBJECTIVES To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD. METHODS This was a retrospective observational study that included all patients diagnosed with NSTE-ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n=232). After exclusion of patients with previous coronary artery bypass grafting (n=30), a multivessel revascularization strategy was adopted in 35.1% of patients (n=71); in the others (n=131, 64.9%), only the culprit artery was revascularized. After propensity score matching (PSM), two groups of 66 patients were obtained, matched according to revascularization strategy. RESULTS During follow-up (1543±545 days), after PSM, patients undergoing multivessel revascularization had lower rates of reinfarction (4.5% vs. 16.7%; log-rank p=0.018), unplanned revascularization (6.1% vs. 16.7%; log-rank p=0.048), unplanned PCI (3.0% vs. 13.6%; log-rank p=0.023) and the combined endpoint of death, reinfarction and unplanned revascularization (16.7 vs. 31.8%; log-rank p=0.046). CONCLUSIONS In real-world patients presenting with NSTE-ACS and multivessel CAD, a multivessel revascularization strategy was associated with lower rates of reinfarction, unplanned revascularization and unplanned PCI, as well as a reduction in the combined endpoint of death, reinfarction and unplanned revascularization.
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Affiliation(s)
- César Correia
- Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal
| | | | | | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Glória Abreu
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Catarina Quina
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | | | - João Costa
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Correia C, Galvão Braga C, Martins J, Arantes C, Abreu G, Quina C, Salgado A, Álvares Pereira M, Costa J, Marques J. Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Shah M, Gajanana D, Wheeler DS, Punjabi C, Maludum O, Mezue K, Lerma EV, Ardati A, Romero-Corral A, Witzke C, Rangaswami J. Effects of staged versus ad hoc percutaneous coronary interventions on renal function—Is there a benefit to staging? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:344-348. [DOI: 10.1016/j.carrev.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
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Gaffar R, Habib B, Filion KB, Reynier P, Eisenberg MJ. Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.005381. [PMID: 28396570 PMCID: PMC5533029 DOI: 10.1161/jaha.116.005381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Studies have suggested that complete revascularization is superior to culprit‐only revascularization for the treatment of enzyme‐positive acute coronary syndrome. However, the optimal timing of complete revascularization remains unclear. We conducted a systematic review and meta‐analysis of randomized controlled trials comparing single‐stage complete revascularization with multistage percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction or non–ST‐segment elevation myocardial infarction with multivessel disease. Methods and Results We systematically searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, and MEDLINE for randomized controlled trials comparing single‐stage complete revascularization with multistage revascularization in patients with enzyme‐positive acute coronary syndrome. The primary outcome was the incidence of major adverse cardiovascular events at longest follow‐up. Data were pooled using DerSimonian and Laird random‐effects models. Four randomized controlled trials (n=838) were included in our meta‐analysis. The risk of unplanned repeat revascularization at longest follow‐up was significantly lower in patients randomized to single‐stage complete revascularization (risk ratio, 0.68; 95% CI, 0.47–0.99). Results also suggest a trend towards lower risks of major adverse cardiovascular events for patients randomized to single‐stage revascularization at 6 months (risk ratio, 0.67; 95% CI, 0.40–1.11) and at longest follow‐up (risk ratio, 0.79; 95% CI, 0.52–1.20). Risks of mortality and recurrent myocardial infarction at longest follow‐up were also lower with single‐stage revascularization, but 95% CIs were wide and included unity. Conclusions Our results suggest that single‐stage complete revascularization is safe. There also appears to be a trend towards lower long‐term risks of mortality and major adverse cardiovascular events; however, additional randomized controlled trials are required to confirm the potential benefits of single‐stage multivessel percutaneous coronary intervention.
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Affiliation(s)
- Rouan Gaffar
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada .,Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Staged versus "one-time" multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:760-767. [PMID: 27899940 PMCID: PMC5122501 DOI: 10.11909/j.issn.1671-5411.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the clinical outcomes of “one-time” versus staged multivessel stenting in elderly (≥ 60 years) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Methods We analyzed data of consecutive NSTE-ACS patients with multivessel percutaneous coronary intervention (PCI) who were enrolled in General Hospital of Shenyang Military Region between 2008 and 2012. A total of 1090 eligible patients aged ≥ 60 were further categorized into “one-time” group (n = 623) and staged PCI group (n = 467) according to intervention strategy. The primary endpoint was composite outcome of myocardial infarction (MI) or cardiac death during 3-year follow-up. Results The estimated 3-year composite rate of cardiac death or MI was 7.0% in the staged PCI group and 9.5% in the “one-time” group (P = 0.110). Multivariate analysis confirmed the benefit of staged PCI on the primary events in the elderly (HR: 0.638, 95% CI: 0.408–0.998, P = 0.049). In a propensity score matched cohort, staged PCI was associated with lower rates of primary events (6.1% vs. 10.4%, P = 0.046) and MI (3.4% vs. 7.4%, P = 0.037) at three years. In addition, there were reduced trends in the stent thrombosis at 30 days (0.3% vs. 1.4%, P = 0.177) and at three years (1.1% vs. 2.4%, P = 0.199) in the staged PCI group. There was no significant difference in the 3-year target vessel revascularization (15.5% vs. 14.4%, P = 0.746). Conclusions In elderly NSTE-ACS patients with MVD, staged PCI might be an optimal strategy associated with reduced long-term cardiac death or MI compared with “one-time” PCI strategy, which needs further confirmation.
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Novel risk factors for acute coronary syndromes and emerging therapies. Int J Cardiol 2016; 220:815-24. [DOI: 10.1016/j.ijcard.2016.06.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/04/2016] [Accepted: 06/24/2016] [Indexed: 02/04/2023]
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Bates ER, Tamis-Holland JE, Bittl JA, O’Gara PT, Levine GN. PCI Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. J Am Coll Cardiol 2016; 68:1066-81. [DOI: 10.1016/j.jacc.2016.05.086] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/19/2016] [Accepted: 05/10/2016] [Indexed: 12/19/2022]
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Hassanin A, Brener SJ, Lansky AJ, Xu K, Stone GW. Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EUROINTERVENTION 2016; 11:293-300. [PMID: 25136882 DOI: 10.4244/eijy14m08_05] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To determine whether multivessel (MV) percutaneous coronary intervention (PCI) performed in one procedure improves outcomes when compared to single-vessel (SV) PCI for the culprit lesion(s) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS We utilised the Acute Catheterisation and Urgent Intervention Triage StrategY (ACUITY) study database to analyse the outcomes of 2,255 patients with MV disease who underwent SV PCI compared to 609 patients who underwent MV PCI in the setting of NSTE-ACS. The primary endpoint was the one-year rate of major adverse cardiac events (MACE): death from any cause, myocardial infarction (MI), or ischaemia-driven revascularisation. At one year, patients undergoing MV PCI compared to SV PCI had similar rates of MACE (24.1% vs. 21.7%, respectively, p=0.11). However, death/MI was significantly higher in the MV PCI group (15.7% vs. 12.6%, p=0.05), primarily driven by higher rates of periprocedural non-Q-wave MI. Rates of death, ischaemia-driven revascularisation, stent thrombosis, acute renal failure and major bleeding were similar in both groups. By multivariable analysis with propensity score adjustment, MV PCI was not an independent predictor of one-year MACE (HR=1.22; 95% confidence interval [CI]: 0.96, 1.55; p=0.12) or death/MI (HR=1.28; 95% CI: 0.95, 1.74; p=0.15). CONCLUSIONS In patients with NSTE-ACS and MV disease, MV PCI does not appear to provide a clear clinical benefit over SV PCI. Randomised clinical trials specifically addressing these two strategies in this population, with attention to quality of life and symptom relief, are warranted.
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Onuma Y, Kimura T, Räber L, Magro M, Girasis C, van Domburg R, Windecker S, Mitsudo K, Serruys PW. Differences in coronary risk factors, procedural characteristics, mortality and stent thrombosis between two all-comers percutaneous coronary intervention registries from Europe and Japan: a patient-level data analysis of the Bern-Rotterdam and j-Cypher registries. EUROINTERVENTION 2016; 11:533-40. [PMID: 24974807 DOI: 10.4244/eijy14m06_09] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The reported rate of stent thrombosis (ST) after drug-eluting stent (DES) implantation varies among registries. To investigate differences in baseline characteristics and clinical outcome in European and Japanese all-comers registries, we performed a pooled analysis of patient-level data. METHODS AND RESULTS The j-Cypher registry (JC) is a multicentre observational study conducted in Japan, including 12,824 patients undergoing SES implantation. From the Bern-Rotterdam registry (BR) enrolled at two academic hospitals in Switzerland and the Netherlands, 3,823 patients with SES were included in the current analysis. Patients in BR were younger, more frequently smokers and presented more frequently with ST-elevation myocardial infarction (MI). Conversely, JC patients more frequently had diabetes and hypertension. At five years, the definite ST rate was significantly lower in JC than BR (JC 1.6% vs. BR 3.3%, p<0.001), while the unadjusted mortality tended to be lower in BR than in JC (BR 13.2% vs. JC 14.4%, log-rank p=0.052). After adjustment, the j-Cypher registry was associated with a significantly lower risk of all-cause mortality (HR 0.56, 95% CI: 0.49-0.64) as well as definite stent thrombosis (HR 0.46, 95% CI: 0.35-0.61). CONCLUSIONS The baseline characteristics of the two large registries were different. After statistical adjustment, JC was associated with lower mortality and ST.
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Affiliation(s)
- Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Mariani J, Macchia A, De Abreu M, Gonzalez Villa Monte G, Tajer C. Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis. PLoS One 2016; 11:e0148756. [PMID: 26886918 PMCID: PMC4757575 DOI: 10.1371/journal.pone.0148756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/15/2016] [Indexed: 01/11/2023] Open
Abstract
Background Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed. Methods A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model. Results Twelve studies were included (n = 117,685). Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%), with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%), revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9%) or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%). All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger’s test p = 0.097). Conclusion Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.
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Affiliation(s)
- Javier Mariani
- Cardiology Department, Hospital El Cruce “Néstor Carlos Kirchner”, Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina
- Fundación GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad Autónoma de Buenos Aires, Argentina
- * E-mail:
| | - Alejandro Macchia
- Fundación GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maximiliano De Abreu
- Cardiology Department, Hospital El Cruce “Néstor Carlos Kirchner”, Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina
| | - Gabriel Gonzalez Villa Monte
- Cardiology Department, Hospital El Cruce “Néstor Carlos Kirchner”, Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina
| | - Carlos Tajer
- Cardiology Department, Hospital El Cruce “Néstor Carlos Kirchner”, Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina
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Liu Z, Zhao L, Li Y, Wang Z, Liu L, Zhang F. Evaluation of early interventional treatment opportunity of the elderly & high-risk patients with non-ST segment elevation acute myocardial infarction. Pak J Med Sci 2015; 31:1053-6. [PMID: 26648985 PMCID: PMC4641254 DOI: 10.12669/pjms.315.7881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To investigate the effect of treatment on prognosis of patients with different timing of early interventional treatment for non-ST segment elevation acute myocardial infarction (NSTEMI). Methods: Forty two cases above 75 years old, diagnosed with high-risk on NSTEMI, were selected in cardiology department of Xinxiang central hospital. They were randomly divided into two groups: 22 in group A and 20 in group B. Group A was performed PCI surgery within 12 hours after the onset while group B from 12 to 24 hour after the onset. Major adverse cardiovascular events (including death, heart failure readmission rates after ischemia, malignant arrhythmias, again target vessel revascularization) and bleeding data were recorded at the three terms of hospitalization, one month after the onset and six months after the onset. Results: Angina, malignant arrhythmia and heart failure during hospitalization can be reduced after interventional treatment carried out within 12 hours after the onset. Readmission rates after ischemia, heart failure and the incidence of death can be significantly reduced after interventional treatment carried out during 1-6 month after the onset with no significant increase in bleeding rate. Conclusion: In the treatment of elderly patients with NSTEMI, early interventional treatment is safe and effective.
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Affiliation(s)
- Zhiqiang Liu
- Zhiqiang Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lipei Zhao
- Lipei Zhao, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Yibo Li
- Yibo Li, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Zhifang Wang
- Zhifang Wang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lingling Liu
- Lingling Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Fucheng Zhang
- Fucheng Zhang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
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Qiao Y, Li W, Mohamed S, Nie S, Du X, Zhang Y, Jia C, Wang X, Liu X, Ma C. A comparison of multivessel and culprit vessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients with multivessel disease: a meta-analysis. EUROINTERVENTION 2015; 11:525-32. [DOI: 10.4244/eijv11i5a104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DS, Cho KI, Kim BH, Park YH, Je HG. Meta-analysis of multivessel versus culprit-only percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome and multivessel coronary disease. Am J Cardiol 2015; 115:1027-32. [PMID: 25724783 DOI: 10.1016/j.amjcard.2015.01.530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 11/17/2022]
Abstract
Even in the era of contemporary drug-eluting stents, it is not clear whether percutaneous coronary intervention (PCI) for nonculprit lesions can improve long-term outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with multivessel coronary disease. Relevant studies published through August 2014 were searched and identified in the electronic databases. Summary estimates were obtained using a random-effects model. From 368 initial citations, 8 observational studies with 8,425 patients (3,227 multivessel and 5,198 culprit-only PCI) were included. Mean follow-up duration was 18 months. There were no significant differences in all-cause mortality (odds ratios [ORs] 0.85, 95% confidence interval [CI] 0.70 to 1.04) and myocardial infarction (OR 0.86, 95% CI 0.55 to 1.35). However, multivessel PCI was associated with a significantly lower rate of repeat revascularization (OR 0.75, 95% CI 0.56 to 1.00). Comparison of multivessel versus culprit-only PCI disclosed OR for major adverse cardiac events of 0.74 (95% CI 0.57 to 0.97). In conclusion, multivessel PCI reduced repeat revascularization without significant benefits in terms of mortality or myocardial infarction at the long-term follow-up in patients with NSTE-ACS and multivessel coronary disease. Future randomized studies that examine the safety and efficacy of multivessel PCI in NSTE-ACS are warranted.
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Affiliation(s)
- Jae-Sik Jang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
| | - Han-Young Jin
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Jeong-Sook Seo
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Tae-Hyun Yang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Dae-Kyeong Kim
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Dong-Soo Kim
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Kyoung-Im Cho
- Department of Cardiology, Kosin University Medical Center, Busan, Korea
| | - Bo-Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yong Hyun Park
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung-Gon Je
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Moretti C, D'Ascenzo F, Quadri G, Omedè P, Montefusco A, Taha S, Cerrato E, Colaci C, Chen SL, Biondi-Zoccai G, Gaita F. Management of multivessel coronary disease in STEMI patients: A systematic review and meta-analysis. Int J Cardiol 2015; 179:552-7. [PMID: 25453403 DOI: 10.1016/j.ijcard.2014.10.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/04/2014] [Accepted: 10/18/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
| | - Giorgio Quadri
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Salma Taha
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | - Chiara Colaci
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy
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Percutaneous coronary intervention in treatment of multivessel coronary artery disease in patients with non-ST-segment elevation acute coronary syndrome. Adv Cardiol 2014; 9:136-45. [PMID: 24570706 PMCID: PMC3915974 DOI: 10.5114/pwki.2013.35448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/22/2013] [Accepted: 05/09/2013] [Indexed: 11/23/2022]
Abstract
Among patients with non-ST-elevated acute coronary syndromes (NSTE-ACS) the estimated percentage of single vessel coronary artery disease (SV-CAD) observed during coronarography is about 20-40%, while multivessel coronary artery disease (MV-CAD) is found in about 40-60%. Further treatment in patients with both SV CAD and MV CAD is usually culprit vessel percutaneous coronary intervention (CV-PCI). Nevertheless, in the group of patients with MV-CAD there is still a problematic decision whether the non-infarct related arteries (non-IRA) should be treated with PCI. According to the European Society of Cardiology (ESC) guidelines on myocardial revascularization this decision should be based on the overall clinical and angiographic status of the patient; simultaneously they suggest performing ad hoc CV-PCI. The decision of performing intervention in the rest of the narrowed coronary arteries should be made after consultation with the heart team or according to the protocols adopted in the specific clinic. Furthermore, there is a question of whether the procedure should be performed immediately after culprit vessel revascularization or it should be postponed until the patient is stabilized. Due to the lack of specific recommendations we decided to perform an analysis of existing studies which compared culprit versus multivessel revascularization in patients with MV-CAD and non-ST-elevated acute coronary syndromes.
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28
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Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (From the PL-ACS Registry). Int J Cardiol 2013; 168:250-4. [DOI: 10.1016/j.ijcard.2012.09.086] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/11/2012] [Accepted: 09/15/2012] [Indexed: 11/24/2022]
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Rosner GF, Kirtane AJ, Genereux P, Lansky AJ, Cristea E, Gersh BJ, Weisz G, Parise H, Fahy M, Mehran R, Stone GW. Impact of the Presence and Extent of Incomplete Angiographic Revascularization After Percutaneous Coronary Intervention in Acute Coronary Syndromes. Circulation 2012; 125:2613-20. [DOI: 10.1161/circulationaha.111.069237] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The clinical significance of incomplete coronary revascularization (ICR) after percutaneous coronary intervention in patients with acute coronary syndromes is unknown.
Methods and Results—
We performed quantitative angiography of the entire coronary tree in 2954 patients with acute coronary syndromes in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. ICR was variably defined if any lesion with diameter stenosis (DS) cutoffs ranging from ≥30% to ≥70% with reference vessel diameter ≥2.0 mm remained after percutaneous coronary intervention. The primary outcome was 1-year composite rate of major adverse cardiac events (death, myocardial infarction, or ischemia-driven unplanned revascularization). With the use of DS cutoffs ≥30%, ≥40%, ≥50%, ≥60%, and ≥70%, the prevalence of ICR after percutaneous coronary intervention was 75%, 55%, 37%, 25%, and 17%, respectively. The 1-year major adverse cardiac event rate was increased among patients with ICR using all of the DS cutoffs. ICR (≥50% DS) was associated with higher 1-year rates of myocardial infarction (12.0% versus 8.2%; hazard ratio, 1.50; 95% confidence interval, 1.18–1.89;
P
=0.0007) and ischemia-driven unplanned revascularization (15.7% versus 10.2%; hazard ratio, 1.58; 95% confidence interval, 1.28–1.96;
P
<0.0001), with a trend toward increased mortality (3.1% versus 2.2%; hazard ratio, 1.43; 95% confidence interval, 0.90–2.27;
P
=0.13). By multivariable analysis, ICR (≥50% DS) was an independent predictor of 1-year major adverse cardiac events (hazard ratio, 1.36; 95% confidence interval, 1.12–1.64;
P
=0.002). The impact of ICR on major adverse cardiac events was similar regardless of chronic total occlusion presence, but it was more pronounced with a greater number of nonrevascularized lesions.
Conclusions—
Depending on the threshold of percent DS, ICR was present in 17% to 75% of patients with acute coronary syndromes after percutaneous coronary intervention. Regardless of the threshold, ICR was strongly associated with 1-year myocardial infarction, ischemia-driven unplanned revascularization, and major adverse cardiac events.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00093158.
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Affiliation(s)
- Gregg F. Rosner
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Ajay J. Kirtane
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Philippe Genereux
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Alexandra J. Lansky
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Ecaterina Cristea
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Bernard J. Gersh
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Giora Weisz
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Helen Parise
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Martin Fahy
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Roxana Mehran
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Gregg W. Stone
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
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30
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Bavry AA. Paving the coronaries with stents: okay in acute coronary syndromes? Clin Cardiol 2011; 34:141-2. [PMID: 21400539 DOI: 10.1002/clc.20899] [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: 11/11/2022] Open
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