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Ito T, Mori Y, Kohsaka S, Yamaji K, Ishii H, Kunimura A, Amano T, Yokoi M, Seo Y, Kozuma K. Effects of Transradial Access on In-Hospital Outcomes in Percutaneous Coronary Intervention for Coronary Artery Bypass Graft: Insights from the Japanese Nationwide Database. Am J Cardiol 2024; 226:18-23. [PMID: 38950688 DOI: 10.1016/j.amjcard.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/03/2024]
Abstract
Because of its superior safety profile and improved outcomes, trans-radial percutaneous coronary intervention (TRI) has become the preferred access in percutaneous coronary intervention (PCI) of native coronary disease. This study investigated the impact of TRI on in-hospital outcomes after PCI for coronary artery bypass graft vessels (GV-PCI). We analyzed patients who underwent GV-PCI in 2019-2022 from the Japanese nationwide registry. Patients were categorized into the TRI and trans-femoral PCI (TFI) groups. We assessed the association between TRI and in-hospital outcomes. The primary outcome was a composite of in-hospital death and major bleeding. In this study, 2,295 patients were analyzed.. The primary outcomes occurred in 29 patients (1.3%), including 17 deaths (0.7%). Major bleeding occurred in 12 patients (0.5%), and access site bleeding in 7 patients (0.3%). The TRI group (n = 1,521) showed lower crude rates of the primary outcome (0.9% vs 1.9%, p = 0.039), major bleeding (0.3% vs 1.0%, p = 0.027), and access site bleeding (0.1% vs 0.6%, p = 0.047) compared with the TFI group (n = 774). Univariable logistic regression demonstrated a significant association of TRI with reduced primary outcome (odd ratio [OR] 0.47, 95% confidence interval [CI] 0.22 to 0.98), major bleeding (OR 0.25, 95% CI 0.07 to 0.80), and access site bleeding (OR 0.20, 95% CI 0.03 to 0.94). In the multivariable analysis, TRI was still significantly associated with a decrease in major bleeding events (OR 0.29, 95% CI 0.07 to 0.93). In conclusion, the use of TRI was associated with a reduction in bleeding events when referenced to TFI in the context of GV-PCI.
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Affiliation(s)
- Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi Japan
| | - Ayako Kunimura
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Kim WC, Hirsch G, Kells C, Quraishi AUR, Bishop H, Kidwai B, Title L, Beydoun H, Sandila N, Sumaya W, Elkhateeb O. Single-Centre Registry Analysis of Patients Who Underwent Percutaneous Coronary Intervention on Their Coronary Bypass Grafts. CJC Open 2024; 6:548-555. [PMID: 38559334 PMCID: PMC10980898 DOI: 10.1016/j.cjco.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 04/04/2024] Open
Abstract
Background The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates. Methods A single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI. Results The median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome. Conclusions Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.
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Affiliation(s)
- Wan Cheol Kim
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Gregory Hirsch
- Division of Cardiac Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Catherine Kells
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ata-Ur-Rehman Quraishi
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Helen Bishop
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Bakhtiar Kidwai
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lawrence Title
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Hussein Beydoun
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Navjot Sandila
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Wael Sumaya
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Osama Elkhateeb
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Shirasu T, Yodsanit N, Li J, Huang Y, Xie X, Tang R, Wang Q, Zhang M, Urabe G, Webb A, Wang Y, Wang X, Xie R, Wang B, Kent KC, Gong S, Guo LW. Neointima abating and endothelium preserving - An adventitia-localized nanoformulation to inhibit the epigenetic writer DOT1L. Biomaterials 2023; 301:122245. [PMID: 37467597 PMCID: PMC10530408 DOI: 10.1016/j.biomaterials.2023.122245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/05/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
Open vascular reconstructions such as bypass are common treatments for cardiovascular disease. Unfortunately, neointimal hyperplasia (IH) follows, leading to treatment failure for which there is no approved therapy. Here we combined the strengths of tailoring nanoplatforms for open vascular reconstructions and targeting new epigenetic mechanisms. We produced adhesive nanoparticles (ahNP) that could be pen-brushed and immobilized on the adventitia to sustainably release pinometostat, an inhibitor drug selective to the epigenetic writer DOT1L that catalyzes histone-3 lysine-79 dimethylation (H3K79me2). This treatment not only reduced IH by 76.8% in injured arteries mimicking open reconstructions in obese Zucker rats with human-like diseases but also avoided the shortcoming of endothelial impairment in IH management. In mechanistic studies, chromatin immunoprecipitation (ChIP) sequencing revealed co-enrichment of the histone mark H3K27ac(acetyl) and its reader BRD4 at the gene of aurora kinase B (AURKB), where H3K79me2 was also enriched as indicated by ChIP-qPCR. Accordingly, DOT1L co-immunoprecipitated with H3K27ac. Furthermore, the known IH driver BRD4 governed the expression of DOT1L which controlled AURKB's protein level, revealing a BRD4- > DOT1L- > AURKB axis. Consistently, AURKB-selective inhibition reduced IH. Thus, this study presents a prototype nanoformulation suited for open vascular reconstructions, and the new insights into chromatin modulators may aid future translational advances.
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Affiliation(s)
- Takuro Shirasu
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Nisakorn Yodsanit
- Department of Biomedical Engineering and Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Jing Li
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Yitao Huang
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA; The Biomedical Sciences Graduate Program (BIMS), School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Xiujie Xie
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Runze Tang
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Qingwei Wang
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Mengxue Zhang
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Go Urabe
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Amy Webb
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Yuyuan Wang
- Department of Biomedical Engineering and Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Xiuxiu Wang
- Department of Biomedical Engineering and Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Ruosen Xie
- Department of Biomedical Engineering and Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Bowen Wang
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - K Craig Kent
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA.
| | - Shaoqin Gong
- Department of Biomedical Engineering and Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA.
| | - Lian-Wang Guo
- Division of Surgical Sciences, Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA; Department of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, VA, 22908, USA; Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, 22908, USA.
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4
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Beerkens FJ, Cao D, Batchelor W, Sartori S, Kandzari DE, Davis S, Tamis L, Wang JC, Othman I, Vogel B, Spirito A, Subramaniam V, Gigliotti OS, Haghighat A, Feng Y, Singh S, Lopez M, Giugliano G, Horwitz PA, Dangas G, Mehran R. Percutaneous Coronary Intervention in Men, Women, and Minorities With a Previous Coronary Artery Bypass Graft Surgery (from the Pooled PLATINUM Diversity and PROMUS Element Plus Registries). Am J Cardiol 2023; 200:204-211. [PMID: 37354778 DOI: 10.1016/j.amjcard.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
There is limited data on new-generation stent outcomes in patients with previous coronary artery bypass graft (CABG) and the associated risk of gender and race/ethnicity is unclear. We investigated 1-year outcomes after platinum chromium everolimus-eluting stent implantation in a diverse population of men, women, and minorities with previous CABG pooled from the PLATINUM Diversity (NCT02240810) and PROMUS Element Plus (NCT01589978) registries. Our primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1-year post percutaneous coronary intervention (PCI). Secondary end points included all-cause death, MI, TVR, target vessel failure, and stent thrombosis. A total of 4,175 patients were included in the analysis, including 1,858 women (44.5%), 1,057 minorities (25.3%), and 662 (15.9%) with previous CABG. Patients with previous CABG were older, included more men and White patients, and had more co-morbidities compared with patients without previous CABG. At 1 year, patients with previous CABG had a higher risk of MACE (12.6% vs 7.5%, hazard ratio 1.70, 95% confidence interval 1.32 to 2.19, p <0.001) and end points, including death/MI, TVR, and target vessel failure. After multivariate adjustment, no differences were observed in MACE (adjusted hazard ratio 1.11, 95% confidence interval 0.82 to 1.49, p = 0.506) or any secondary end points. No interaction was observed between previous CABG and gender or minority status. In conclusion, in a contemporary PCI population, patients with previous CABG remain at high risk for PCI because of their elevated risk profile. Previous CABG status was however not independently associated with worse outcomes after adjustment, nor was any interaction observed with gender or race/ethnicity.
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Affiliation(s)
- Frans J Beerkens
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Wayne Batchelor
- Inova Heart and Vascular Institute, Inova Health System, Fairfax, Virginia
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Scott Davis
- Interventional Cardiology, Baptist Hospital, Little Rock, Arkansas
| | - Luis Tamis
- Research Physicians Network Alliance, Hollywood, Florida
| | - John C Wang
- Department of Interventional Cardiology, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Islam Othman
- Division of Cardiology, Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Varsha Subramaniam
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Amir Haghighat
- Cardiovascular Institute of Northwest Florida, Panama City, Florida
| | - Yihan Feng
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Mario Lopez
- Charlotte Heart and Vascular Institute, Port Charlotte, Florida
| | - Gregory Giugliano
- Interventional Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Indiana
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York.
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5
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Siry M, Duymaz B, Biesenberger S, Siry D, Kammerer V, May AE. Self-Expanding Versus Balloon Expanding Coronary Stents in Intervention of the Degenerated Saphenous Vein Graft: Memmingen Coronary Artery Bypass Stenosis Trial (MECAST). J Interv Cardiol 2023; 2023:9412132. [PMID: 37064643 PMCID: PMC10101740 DOI: 10.1155/2023/9412132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 04/08/2023] Open
Abstract
Objectives. The aim of this retrospective analysis was to compare the patient outcome after interventional therapy of saphenous vein graft (SVG) stenoses in an all-comers population receiving either self-expanding drug-eluting stents (SExS) or balloon expanding drug-eluting stents (BExS). Background. The interventional therapy of degenerated SVGs remains challenging. Diameter variations of stenotic segments and friable plaques can lead to malapposition and distal embolization with increased major adverse cardiac event (MACE) rates. Methods. 107 patients with a total of 130 SVG interventions were separated into two groups according to either SExS (n = 51) or BExS (n = 56) treatment. Primary endpoint was the MACE rate, which is defined as the composite of cardiac death, myocardial infarction (MI), target vessel (TVR), and target lesion revascularization (TLR) at 30 days and at one-year follow-up. Results. Both patient groups did not differ significantly regarding patient characteristics. The patient outcome was significantly better in the SExS patient group: the MACE rate at 30 days was 1/51 (2.0%) in group SExS vs. 7/56 (12.5%) in group BExS;
. At one-year follow-up, the MACE rate remained significantly lower in the SExS group 8/51(15.7%) vs. 20/56 (35.7%) in the BExS group,
. Additionally, cardiac death occurred significantly later within the SExS patient group compared to the BExS group (
). A better overall outcome of patients with de novo SVG-stenosis compared to patients with previous CABG (coronary artery bypass graft) intervention was noted in both groups. Conclusion. Our findings demonstrate that SVG treatment with SExS is safe and provides clinical benefits by comparatively improving short and especially long-term patient outcomes.
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Affiliation(s)
- Marcus Siry
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
| | - Burak Duymaz
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
| | | | - Deborah Siry
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
| | | | - Andreas E. May
- Medizinische Klinik I, Klinikum Memmingen, Memmingen, Germany
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Voll F, Koch T, Lenz T, Cassese S, Xhepa E, Joner M, Kastrati A, Kufner S. Coronary artery perforation located in a coronary artery bypass graft treated with new-generation single-layer polytetrafluorethylene-covered stent: results from a multicenter Registry. Coron Artery Dis 2023; 34:160-162. [PMID: 36539951 DOI: 10.1097/mca.0000000000001210] [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: 12/24/2022]
Affiliation(s)
- Felix Voll
- Deutsches Herzzentrum München, Technische Universität München
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München
| | - Tobias Lenz
- Deutsches Herzzentrum München, Technische Universität München
| | | | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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7
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Lin L, Lu W, Wang X, Pan L, Wang X, Zheng X, Li R, Shan Y, Peng M, Qiu C. Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease. Front Cardiovasc Med 2023; 10:982880. [PMID: 36950290 PMCID: PMC10025469 DOI: 10.3389/fcvm.2023.982880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a device for percutaneous coronary intervention, drug-coated balloon (DCB) is widely used to treat in-stent restenosis. However, data regarding the use of DCB in treating de novo saphenous vein graft (SVG) lesions are limited. This study aimed to explore the outcomes of using the DCB in the treatment of de novo SVG lesions of coronary heart disease (CHD). Methods This retrospective and observational study analyzed CHD patients with de novo SVG lesions treated with DCB or the new-generation drug-eluting stent (DES) between January 2018 and December 2020. Restenosis was the primary endpoint, whereas target lesion revascularization (TLR), major adverse cardiac events, restenosis, cardiac death, target vessel revascularization, and myocardial infarction were the secondary outcomes. Results We enrolled 31 and 23 patients treated with DCB and DES, respectively. The baseline clinical data, lesion characteristics, and procedural characteristics were similar between the two groups. Twenty-eight (90.3%) patients in the DCB group and 21 (91.3%) in the DES group completed follow-up angiography after 1 year. The quantitative coronary angiography measurements at angiographic follow-up showing late lumen loss were -0.07 ± 0.95 mm for the DCB group and 0.86 ± 0.71 mm for the DES group (P = 0.039), and the rates of restenosis were 13.3% and 21.7% for the DCB and DES groups, respectively (P = 0.470). No significant differences were observed in the rates of MACE (16.7% vs. 26.1%, P = 0.402) and TLR (13.3% vs. 4.3%, P = 0.374) during clinical follow-up. Conclusion Our findings suggest that when pre-dilatation was successful, DCB might be safe and effective in treating de novo SVG lesions.
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8
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Bharadwaj AS, Mamas MA. Saphenous Vein Graft Intervention. Interv Cardiol Clin 2022; 11:383-391. [PMID: 36243484 DOI: 10.1016/j.iccl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Even though saphenous vein grafts (SVGs) are the most commonly used surgical conduits, their long-term patency is limited by accelerated atherosclerosis often resulting in acute coronary syndrome or asymptomatic occlusion. SVG intervention is associated with 2 significant challenges: a significant risk of distal embolization with resultant periprocedural myocardial infarction in the short-term and restenosis in the long-term. Several individual trials have compared bare metal stents with drug-eluting stents for SVG intervention. This review article discusses the pathophysiology of SVG lesions, indications for SVG intervention, and the challenges encountered, and also technical considerations for SVG intervention and the supporting evidence.
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Affiliation(s)
- Aditya S Bharadwaj
- Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Suite 2422, Loma Linda, CA 92354, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK.
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9
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Claessen B, Beerkens F, Henriques JP, Dangas GD. Percutaneous Coronary Intervention of Arterial and Vein Grafts. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Beerkens FJ, Claessen BE, Mahan M, Gaudino MFL, Tam DY, Henriques JPS, Mehran R, Dangas GD. Contemporary coronary artery bypass graft surgery and subsequent percutaneous revascularization. Nat Rev Cardiol 2022; 19:195-208. [PMID: 34611327 DOI: 10.1038/s41569-021-00612-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/09/2022]
Abstract
Patients who have undergone coronary artery bypass graft (CABG) surgery are susceptible to bypass graft failure and progression of native coronary artery disease. Although the saphenous vein graft (SVG) was traditionally the most-used conduit, arterial grafts (including the left and right internal thoracic arteries and the radial artery) have improved patency rates. However, the need for secondary revascularization remains common, and percutaneous coronary intervention (PCI) has become the most common modality of secondary revascularization after CABG surgery. Procedural characteristics and clinical outcomes differ considerably from those associated with PCI in patients without previous CABG surgery, owing to altered coronary anatomy and differences in conduit pathophysiology. In particular, SVG PCI carries an increased risk of complications, and operators are shifting their focus towards embolic protection strategies and complex native-vessel interventions, increasingly using SVGs as conduits to facilitate native-vessel PCI rather than pursuing SVG PCI. In this Review, we discuss the differences in conduit pathophysiology, changes in CABG surgery techniques, and the latest evidence in terms of PCI in patients with previous CABG surgery, with a particular emphasis on safety and long-term efficacy. We explore the subject of contemporary CABG surgery and subsequent percutaneous revascularization in this complex patient population.
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Affiliation(s)
- Frans J Beerkens
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bimmer E Claessen
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marielle Mahan
- Department of Ophthalmology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Derrick Y Tam
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - José P S Henriques
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George D Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Xenogiannis I, Rangan BV, Uyeda L, Banerjee S, Edson R, Bhatt DL, Goldman S, Holmes DR, Rao SV, Shunk K, Mavromatis K, Ramanathan K, Bavry AA, McFalls EO, Garcia S, Thai H, Uretsky BF, Latif F, Armstrong E, Ortiz J, Jneid H, Liu J, Aggrawal K, Conner TA, Wagner T, Karacsonyi J, Ventura B, Alsleben A, Lu Y, Shih MC, Brilakis ES. In-Stent Restenosis in Saphenous Vein Grafts (from the DIVA Trial). Am J Cardiol 2022; 162:24-30. [PMID: 34736721 DOI: 10.1016/j.amjcard.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
Saphenous vein grafts (SVGs) have high rates of in-stent restenosis (ISR). We compared the baseline clinical and angiographic characteristics of patients and lesions that did develop ISR with those who did not develop ISR during a median follow-up of 2.7 years in the DIVA study (NCT01121224). We also examined the ISR types using the Mehran classification. ISR developed in 119 out of the 575 DIVA patients (21%), with similar incidence among patients with drug-eluting stents and bare-metal stents (BMS) (21% vs 21%, p = 0.957). Patients in the ISR group were younger (67 ± 7 vs 69 ± 8 years, p = 0.04) and less likely to have heart failure (27% vs 38%, p = 0.03) and SVG lesions with Thrombolysis In Myocardial Infarction 3 flow before the intervention (77% vs 83%, p <0.01), but had a higher number of target SVG lesions (1.33 ± 0.64 vs 1.16 ± 0.42, p <0.01), more stents implanted in the target SVG lesions (1.52 ± 0.80 vs 1.31 ± 0.66, p <0.01), and longer total stent length (31.37 ± 22.11 vs 25.64 ± 17.42 mm, p = 0.01). The incidence of diffuse ISR was similar in patients who received drug-eluting-stents and BMS (57% vs 54%, p = 0.94), but BMS patients were more likely to develop occlusive restenosis (17% vs 33%, p = 0.05).
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Bavana V Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Lauren Uyeda
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Edson
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | | | | | - David R Holmes
- Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Sunil V Rao
- Durham Veteran Affairs Medical Center, Durham, North Carolina
| | - Kendrick Shunk
- San Francisco Veteran Affairs Medical Center, San Francisco, California
| | | | | | - Antony A Bavry
- North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Edward O McFalls
- Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota; Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Hoang Thai
- Desert Cardiology of Tucson, Tucson, Arizona
| | - Barry F Uretsky
- John L. McClellan Memorial Veteran Affairs Medical Center, Little Rock, Arkansas
| | - Faisal Latif
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma
| | | | - Jose Ortiz
- Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio
| | - Hani Jneid
- Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, Texas
| | - Jayson Liu
- Hines/North Chicago Veteran Affairs Medical Center, Hines, Illinois
| | - Kul Aggrawal
- Harry S. Truman Memorial VA Medical Center, Columbia, Missouri
| | - Todd A Conner
- Veteran Affairs Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico
| | - Todd Wagner
- Health Economics Resource Center, VA Palo Alto, California
| | - Judit Karacsonyi
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Beverly Ventura
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Aaron Alsleben
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Ying Lu
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Mei-Chiung Shih
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota.
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12
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Beerkens FJ, Singh R, Cao D, Claessen BE, Nicolas J, Sartori S, Snyder C, Camaj A, Giustino G, Power D, Razuk V, Jones D, Tavenier AH, Pivato CA, Nardin M, Chiarito M, Krishnan P, Barman N, Baber U, Sweeny J, Dangas G, Sharma SK, Mehran R, Kini A. Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft. Catheter Cardiovasc Interv 2021; 98:E785-E795. [PMID: 34478235 DOI: 10.1002/ccd.29935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. BACKGROUND Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. METHODS We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI. RESULTS Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow- and no-reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56-8.95; p < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. CONCLUSIONS Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.
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Affiliation(s)
- Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ranbir Singh
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bimmer E Claessen
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johny Nicolas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clayton Snyder
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anton Camaj
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Victor Razuk
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davis Jones
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne H Tavenier
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Isala, Zwolle, The Netherlands
| | - Carlo Andrea Pivato
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matteo Nardin
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph Sweeny
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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13
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Nardone EW, Madsen BM, McCarey MM, Fischman DL, Ruggiero NJ, Walinsky P, Vishnevsky A, Savage MP. Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility? World J Cardiol 2021; 13:493-502. [PMID: 34621494 PMCID: PMC8462047 DOI: 10.4330/wjc.v13.i9.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy.
AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.
METHODS This was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion.
RESULTS The study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (< 24 h) in 34% of patients, subacute (> 24 h to 30 d) in 26%, and late (> 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years.
CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes.
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Affiliation(s)
- Evan W Nardone
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Brandon M Madsen
- Department of Anesthesiology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Melissa M McCarey
- Jefferson Clinical Research Institue, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - David L Fischman
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Nicholas J Ruggiero
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Paul Walinsky
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Alec Vishnevsky
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Michael P Savage
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
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14
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Wolny R, Mintz GS, Pręgowski J, Witkowski A. Mechanisms, Prevention and Treatment of Saphenous Vein Graft Disease. Am J Cardiol 2021; 154:41-47. [PMID: 34256942 DOI: 10.1016/j.amjcard.2021.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
Saphenous vein grafts are imperfect yet indispensable conduits commonly used for coronary artery bypass grafting. Their degeneration ultimately leading to occlusion results from the pathological response of the vein to altered blood rheology and several types of vascular injury. Surgical techniques minimizing vessel damage, and prolonged antiplatelet and lipid-lowering treatment are established methods of mitigating the degeneration process hence preventing graft occlusions. Percutaneous interventions in degenerated vein grafts carry high risk of embolization, periprocedural myocardial infarction and restenosis. Thus, native vessel should be the preferred treatment target in case of graft failure whenever technically feasible.
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15
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Stefanini GG, Alfonso F, Barbato E, Byrne R, Capodanno D, Colleran R, Escaned J, Giacoppo D, Kunadian V, Lansky A, Mehilli J, Neumann FJ, Regazzoli D, Sanz-Sanchez J, Wijns W, Baumbach A. Management of myocardial revascularisation failure: an expert consensus document of the EAPCI. EUROINTERVENTION 2020; 16:e875-e890. [DOI: 10.4244/eij-d-20-00487] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Fahrni G, Farah A, Engstrøm T, Galatius S, Eberli F, Rickenbacher P, Conen D, Mueller C, Pfister O, Twerenbold R, Coslovsky M, Cattaneo M, Kaiser C, Mangner N, Schuler G, Pfisterer M, Möbius‐Winkler S, Jeger RV. Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation in Saphenous Vein Grafts: Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e017434. [PMID: 33032485 PMCID: PMC7763393 DOI: 10.1161/jaha.120.017434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Efficacy data on drug-eluting stents (DES) versus bare-metal stents (BMS) in saphenous vein grafts are controversial. We aimed to compare DES with BMS among patients undergoing saphenous vein grafts intervention regarding long-term outcome. Methods and Results In this multinational trial, patients were randomized to paclitaxel-eluting or BMS. The primary end point was major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target-vessel revascularization at 1 year. Secondary end points included major adverse cardiac events and its individual components at 5-year follow-up. One hundred seventy-three patients were included in the trial (89 DES versus 84 BMS). One-year major adverse cardiac event rates were lower in DES compared with BMS (2.2% versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03-0.64, P=0.01), which was mainly driven by a reduction of subsequent myocardial infarctions and need for target-vessel revascularization. Five-year major adverse cardiac event rates remained lower in the DES compared with the BMS arm (35.5% versus 56.1%, hazard ratio, 0.40; 95% CI, 0.23-0.68, P<0.001). A landmark-analysis from 1 to 5 years revealed a persistent benefit of DES over BMS (hazard ratio, 0.33; 95% CI, 0.13-0.74, P=0.007) in terms of target-vessel revascularization. More patients in the BMS group underwent multiple target-vessel revascularization procedures throughout the study period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8], P=0.013). Enrollment was stopped before the target sample size of 240 patients was reached. Conclusions In this randomized controlled trial with prospective long-term follow-up of up to 5 years, DES showed a better efficacy than BMS with sustained benefits over time. DES may be the preferred strategy in this patient population. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00595647.
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Affiliation(s)
| | - Ahmed Farah
- Klinikum WestfalenDortmundGermany
- Central ClinicBad BerkaGermany
| | | | - Søren Galatius
- Bispebjerg University HospitalCopenhagenDenmark
- Gentofte HospitalHellerupDenmark
| | | | | | - David Conen
- University HospitalBaselSwitzerland
- Population Health Research InstituteMcMaster UniversityHamiltonCanada
| | | | | | | | | | | | | | - Norman Mangner
- Herzzentrum DresdenTechnische Universität DresdenDresdenGermany
- Heart CenterUniversity of LeipzigGermany
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17
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Capodanno D, Morice MC, Angiolillo DJ, Bhatt DL, Byrne RA, Colleran R, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock SJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhovel U, Krucoff MW, Urban P, Mehran R. Trial Design Principles for Patients at High Bleeding Risk Undergoing PCI: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 76:1468-1483. [PMID: 32943165 DOI: 10.1016/j.jacc.2020.06.085] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 01/22/2023]
Abstract
Investigating the balance of risk for thrombotic and bleeding events after percutaneous coronary intervention (PCI) is especially relevant for patients at high bleeding risk (HBR). The Academic Research Consortium for HBR recently proposed a consensus definition in an effort to standardize the patient population included in HBR trials. The aim of this consensus-based document, the second initiative from the Academic Research Consortium for HBR, is to propose recommendations to guide the design of clinical trials of devices and drugs in HBR patients undergoing PCI. The authors discuss the designs of trials in HBR patients undergoing PCI and various aspects of trial design specific to HBR patients, including target populations, intervention and control groups, primary and secondary outcomes, and timing of endpoint reporting.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitario "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy.
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France. https://twitter.com/mc_morice
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBhattMD
| | - Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. https://twitter.com/robebyrne
| | - Roisin Colleran
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de Recherche en Cardiovasculaire et Nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France. https://twitter.com/CuissetDr
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DonaldCutlip
| | | | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Farb
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts; Baim Institute for Clinical Research, Brookline, Massachusetts. https://twitter.com/CMichaelGibson
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Martin B Leon
- Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. https://twitter.com/MartyMleon
| | - P F Adrian Magee
- U.S. Food and Drug Administration, Silver Spring, Maryland. https://twitter.com/dmylotte
| | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway, Ireland
| | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina. https://twitter.com/SVRaoMD
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands. https://twitter.com/ernest_spitzer
| | | | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/vlgmrc
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Ute Windhovel
- Cardiovascular European Research Center, Massy, France. https://twitter.com/Urphi
| | - Mitchel W Krucoff
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina. https://twitter.com/mwkrucoff
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York. https://twitter.com/Drroxmehran
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18
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 4033] [Impact Index Per Article: 1008.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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19
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Riley RF, Henry TD, Mahmud E, Kirtane AJ, Brilakis ES, Goyal A, Grines CL, Lombardi WL, Maran A, Rab T, Tremmel JA, Truesdell AG, Yeh RW, Zhao DX, Jaffer FA. SCAI
position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease. Catheter Cardiovasc Interv 2020; 96:346-362. [DOI: 10.1002/ccd.28994] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Cincinnati Ohio USA
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center University of California San Diego La Jolla California USA
| | - Ajay J. Kirtane
- Center for Interventional Vascular Therapy Columbia University Medical Center New York New York USA
| | | | | | | | | | - Anbukarasi Maran
- Medical University of South Carolina North Charleston South Carolina USA
| | | | | | | | - Robert W. Yeh
- Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - David X. Zhao
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
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20
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Xenogiannis I, Nikolakopoulos I, Vemmou E, Brilakis ES. Chronic total occlusion recanalization for myocardial infarction. Catheter Cardiovasc Interv 2020; 95:1133-1135. [PMID: 31696624 DOI: 10.1002/ccd.28590] [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: 08/02/2019] [Revised: 10/02/2019] [Accepted: 10/27/2019] [Indexed: 11/06/2022]
Abstract
An 84-year-old patient with prior coronary artery bypass surgery presented with non-ST segment elevation acute myocardial infarction. The culprit lesion was at the distal anastomosis of a saphenous vein graft (SVG) to the right posterior descending artery. The proximal right coronary artery was chronically occluded. Because of significant disease both proximal and distal to the SVG anastomosis, percutaneous intervention of the SVG carried high risk for acute vessel closure. The native right coronary artery chronic total occlusion was successfully recanalized, enabling complete revascularization of the right coronary artery. The SVG was then occluded using an Amplatzer vascular plug.
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
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21
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Towards a Saphenous Vein Graft Moratorium. Cardiol Rev 2020; 28:236-239. [DOI: 10.1097/crd.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Clinical benefits of prolonged dual antiplatelet therapy following complex percutaneous coronary intervention. Coron Artery Dis 2019; 31:273-278. [PMID: 31658148 DOI: 10.1097/mca.0000000000000827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Prolonged dual antiplatelet therapy (DAPT) requires consideration of both reduced thrombotic events and increased bleeding risk. The associated subtle balance between the benefits and harms depends upon patient's clinical factors and complexity of the coronary anatomy. Our aim was to assess the safety and efficacy of prolonged (>12 months) DAPT in patients undergoing complex percutaneous coronary intervention (PCI). METHODS AND RESULTS A thorough computer-based search was performed using four major databases. Complex PCI was defined as a procedure with at least one of the following angiographic characteristics: 3 vessels treated, >3 stents implanted, >3 lesions treated, bifurcation lesions, total stent length >60 mm, left main or proximal left anterior descending, a vein graft stent, or chronic total occlusion as target lesion. Of the 3543 titles searched, 5 studies met the inclusion criteria comparing short and prolonged DAPT therapy. We applied a random-effects model to acknowledge the variation in study design, treatment duration, and length of follow-up among studies. There was a reduction in cardiac mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.35-0.92; P = 0.02, I = 0%] and major adverse cardiovascular events (OR 0.76, 95% CI: 0.59-0.96; P = 0.02, I = 22%) with prolonged DAPT. Major bleeding was increased with prolonged DAPT (OR 1.75, 95% CI: 1.20-2.20; P = 0.004, I = 0%). There was no difference in the all-cause mortality (OR 0.86, 95% CI: 0.61-1.22; P = 0.41, I = 0%). CONCLUSION Prolonged DAPT reduces cardiac mortality and major adverse cardiovascular events in complex PCI. The results would need confirmation in a larger randomized study.
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23
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Patel NJ, Bavishi C, Atti V, Tripathi A, Nalluri N, Cohen MG, Kini AS, Sharma SK, Dangas G, Bhatt DL. Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Intervention. Circ Cardiovasc Interv 2019; 11:e007045. [PMID: 30571204 DOI: 10.1161/circinterventions.118.007045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Percutaneous coronary intervention with drug-eluting stents (DES) has been increasingly used for revascularization of saphenous vein graft stenosis without strong clinical evidence favoring their use. Randomized controlled trials comparing DES versus bare-metal stents (BMS) in saphenous vein graft-percutaneous coronary intervention have been inconclusive. Methods and Results We performed a comprehensive literature search through May 15, 2018, for all eligible studies comparing DES versus BMS in patients with saphenous vein graft stenosis in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov. Clinical outcomes included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, myocardial infarction, stent thrombosis, and target vessel revascularization. Six randomized controlled trials were eligible and included 1582 patients, of whom 797 received DES and 785 received BMS. The follow-up period ranged from 18 months to 60 months. There was no statistically significant difference between DES and BMS for all-cause mortality (risk ratio [RR],1.11; 95% CI, 0.0.77-1.62; P=0.57), cardiovascular mortality (RR, 1.00; 95% CI, 0.64-1.57; P=0.99), major adverse cardiovascular events (RR, 0.83; 95% CI, 0.63-1.10; P=20), target vessel revascularization (RR, 0.73; 95% CI, 0.48-1.11; P=0.14), myocardial infarction (RR, 0.74; 95% CI, 0.48-1.16; P=0.19), or stent thrombosis (RR, 1.06; 95% CI, 0.42-2.65; P=0.90). Conclusions In patients undergoing percutaneous coronary intervention for saphenous vein graft lesions, our results showed that there was no significant difference between DES and BMS for mortality, major adverse cardiovascular events, target vessel revascularization, myocardial infarction, or stent thrombosis.
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Affiliation(s)
- Nileshkumar J Patel
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Chirag Bavishi
- Department of Medicine, Division of Cardiology Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence (C.B.)
| | - Varunsiri Atti
- Michigan State University, Sparrow Hospital, East Lansing, MI (V.A.)
| | - Avnish Tripathi
- Massachusetts General Hospital (A.T.), Harvard Medical School, Boston
| | - Nikhil Nalluri
- Staten Island University Hospital, New York City, NY (N.N.)
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami-Miller School of Medicine, FL (M.G.C.)
| | - Annapoorna S Kini
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Samin K Sharma
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - George Dangas
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, (D.L.B.), Harvard Medical School, Boston
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24
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Kheiri B, Osman M, Bachuwa G, Cigarroa JE. Trial Sequential Analysis of Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Intervention. Am J Cardiol 2019; 124:823-824. [PMID: 31272706 DOI: 10.1016/j.amjcard.2019.05.043] [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: 05/14/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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25
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Locker C, Greiten LE, Bell MR, Frye RL, Lerman A, Daly RC, Greason KL, Said SM, Lahr BD, Stulak JM, Dearani JA, Schaff HV. Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization. Mayo Clin Proc 2019; 94:1743-1752. [PMID: 31486379 DOI: 10.1016/j.mayocp.2019.01.048] [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: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. METHODS From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. RESULTS In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95%CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95% CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61% (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95% CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95% CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48% vs 33% (HR, 0.57; 95% CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95% CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95% CI, 0.75-1.59; P=.65). CONCLUSION RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.
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Affiliation(s)
- Chaim Locker
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | | | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert L Frye
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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26
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Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, Karmpaliotis D, Mashayekhi K, Furkalo S, Cavalcante JL, Burke MN, Brilakis ES. Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2019; 12:1635-1649. [DOI: 10.1016/j.jcin.2019.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
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27
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Affiliation(s)
- Michael P Savage
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA
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28
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Shah R, Hesterberg K. Drug-eluting stents versus bare-metal stents for saphenous vein graft interventions. J Thorac Dis 2019; 11:S1257-S1260. [PMID: 31245102 DOI: 10.21037/jtd.2019.02.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rahman Shah
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kirstin Hesterberg
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
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29
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Rodriguez AE, Larribau M, Fernandez-Pereira C, Iravedra J, Santaera O, Haiek C, Lloberas J, Montoya M, Sisu E, Menendez M, Pavlovsky H, Rodriguez-Granillo AM, Mieres J, Romero G, Ming Z, Pan W, Antoniucci D. One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819854059. [PMID: 31285655 PMCID: PMC6600492 DOI: 10.1177/1179546819854059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate 1-year follow-up results in an all “comers”
population treated with a new cobalt chromium bare-metal stent (BMS) design.
Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive
patients undergoing coronary stent implantation in 11 centers in Argentina were
prospectively included in our registry. The inclusion criteria were
multiple-vessel disease and/or unprotected left main disease, acute coronary
syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major
epicardial vessel. In-stent restenosis, protected left main stenosis, or
impossibility to receive dual-antiplatelet therapy was an exclusion criterion.
Major adverse cardiac events (MACE) were the primary endpoint and included
cardiac death, myocardial infarction (MI), and target lesion revascularization
(TLR); also, all components of the primary endpoint were separately analyzed.
Completeness of revascularization was analyzed as post hoc data using residual
SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of
patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel
disease, 67% have ACS, and 32% have ST elevation MI. At a mean of
376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients:
death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac
death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with
98% of event-free survival (P < .04). In conclusion, this
prospective, multicenter, and observational all-comers registry with this novel
BMS design showed a low incidence of adverse events at 1 year mainly due to
coronary restenosis.
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Affiliation(s)
- Alfredo E Rodriguez
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina
| | - Miguel Larribau
- Department of Interventional Cardiology, Hospital Español de Mendoza, Mendoza, Argentina.,Department of Interventional Cardiology, Clinica de Cuyo, Mendoza, Argentina
| | - Carlos Fernandez-Pereira
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Jorge Iravedra
- Department of Interventional Cardiology, Clinica 25 de Mayo, Buenos Aires, Argentina
| | - Omar Santaera
- Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Carlos Haiek
- Department of Interventional Cardiology, Sanatorio de la Trinidad Quilmes, Buenos Aires, Argentina
| | - Juan Lloberas
- Department of Interventional Cardiology, Sanatorio San Miguel, Buenos Aires, Argentina
| | - Mario Montoya
- Department of Interventional Cardiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Elias Sisu
- Department of Interventional Cardiology, Clinica Ipensa, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Alfredo M Rodriguez-Granillo
- Department of Clinical Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Biostatistical Analysis, Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Juan Mieres
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Graciela Romero
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Zheng Ming
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - William Pan
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - David Antoniucci
- Division of Cardiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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30
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Sethi A, Singbal Y, Prasad V. Is it time to abandon drug-eluting stents for saphenous venous graft percutaneous coronary intervention? EUROINTERVENTION 2019; 15:209-210. [PMID: 31217155 DOI: 10.4244/eij-d-18-00666l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ankur Sethi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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31
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Elgendy IY, Mahmoud AN, Brilakis ES, Bavry AA. Reply to the Letter to the Editor "Is it time to abandon drug-eluting stents for saphenous venous graft percutaneous coronary intervention?". EUROINTERVENTION 2019; 15:211-212. [PMID: 31217156 DOI: 10.4244/eij-d-18-00666r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Islam Y Elgendy
- Department of Medicine, University of Florida, Gainesville, FL, USA
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32
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Hall AB, Brilakis ES. Saphenous vein graft failure: seeing the bigger picture. J Thorac Dis 2019; 11:S1441-S1444. [PMID: 31245156 PMCID: PMC6560559 DOI: 10.21037/jtd.2019.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Allison B Hall
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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33
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Davies RE, Abbott JD. Percutaneous Coronary Intervention: Developments in the Last 12 Months. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2019.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In 2018, there were several studies that significantly added to the field of interventional cardiology. Research was focused on understanding the role of percutaneous coronary intervention (PCI) in various clinical syndromes, optimizing outcomes for high-risk lesion subsets, and building an evidence base for greater adoption of PCI guided by physiology and intracoronary imaging. In the area of innovation, novel and iterative developments in drug-eluting stents (DES) and scaffold platforms were compared with current generation DES. This article summarizes the research from last year which has had the most impact on PCI techniques and clinical care.
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Affiliation(s)
- Rhian E Davies
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, RI
| | - J Dawn Abbott
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, RI
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34
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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35
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Hall AB, Brilakis ES. Treating saphenous vein graft lesions: Drug-eluting stents are not the answer! Catheter Cardiovasc Interv 2019; 93:E193-E194. [PMID: 30770658 DOI: 10.1002/ccd.28011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
Abstract
Saphenous vein graft (SVG) percutaneous coronary intervention carries high rates of acute (no reflow and periprocedural myocardial infarction) and long-term (restenosis and re-occlusion) complications. Long-term follow-up from the two largest trials of drug-eluting vs. bare metal stents in SVG lesions (The Drug-Eluting Stents vs. Bare Metal Stents In Saphenous Vein graft Angioplasty and Is Drug-Eluting-Stenting Associated with Improved Results in Coronary Artery Bypass Grafts? Trial) definitely show no difference between the two stent types, suggesting that bare metal stents should be preferred given lower cost. Since SVG stenting remains associated with high failure rates, alternative treatment strategies, such as intervention of the corresponding native coronary artery lesions, may represent the future direction of the field.
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Affiliation(s)
- Allison B Hall
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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36
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Koppara T, Joner M. Shedding Light Into Late Saphenous Vein Graft Failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:6-8. [PMID: 30744828 DOI: 10.1016/j.carrev.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Tobias Koppara
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; Deutsches Zentrum für Herz- und Kreislaufforschung e.V., Berlin, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Munich, Germany; Deutsches Zentrum für Herz- und Kreislaufforschung e.V., Berlin, Germany
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37
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Wan S, Cheng ZY. Taking care of the soldiers. J Thorac Dis 2019; 10:S4002-S4005. [PMID: 30631539 DOI: 10.21037/jtd.2018.09.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Song Wan
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Zhao-Yun Cheng
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou 450046, China
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38
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Garg A, Rout A, Tayal R, Sharma A, Agrawal S, Kostis JB, Cohen M, Sharma S, Wasty N. Drug-eluting Stents Versus Bare-metal Stents for Saphenous Vein Graft Interventions: A Systematic Review and Meta-analysis of Studies With Longer Follow-up. Curr Probl Cardiol 2019; 46:100405. [PMID: 30792045 DOI: 10.1016/j.cpcardiol.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Abstract
Randomized controlled trials comparing drug eluting stents (DES) with bare-metal stents (BMS) for saphenous vein graft (SVG) interventions have shown conflicting results. We conducted this meta-analysis to evaluate the cumulative evidence for long-term efficacy and safety of DES vs BMS in SVG lesions. A systematic search was conducted of Randomized controlled trials comparing DES vs BMS in patients undergoing percutaneous interventions for SVG lesions. End-points of interest were all-cause death, cardiac death, myocardial infarction, target lesion revascularization and target vessel revascularization at longest available follow-up. Random effects meta-analysis was conducted to estimate risk ratio with 95% confidence intervals for individual end-points. Seven studies with 1639 patients were included in the final analysis. Mean follow-up period was 32 months. Compared with BMS, DES was associated with similar risks of all-cause death (risk ratio 1.06; 95% confidence intervals 0.76-1.48) and cardiac death (0.95; 0.59-1.54). Similarly, there were no differences between DES and BMS in terms of myocardial infarction (0.81; 0.50-1.29), target vessel revascularization (0.73; 0.48-1.110 or target lesion revascularization (1.05; 0.76-1.43). Current analysis suggests no strong evidence for routine DES use in patients undergoing SVG intervention. Future studies should evaluate if SVG lesion characteristics could influence these results.
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39
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Long-term outcomes of drug-eluting stents versus bare metal stents in saphenous vein graft interventions. Evidence from a meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:951-955. [DOI: 10.1016/j.carrev.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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40
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Truong HTD, Shanmugasundaram M. Saphenous vein graft interventions. Is it worth our time? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:903-904. [PMID: 30316774 DOI: 10.1016/j.carrev.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Huu Tam D Truong
- Southern Arizona VA Healthcare System, Tucson, AZ, USA; University of Arizona, College of Medicine, Tucson, AZ, USA.
| | - Madhan Shanmugasundaram
- Southern Arizona VA Healthcare System, Tucson, AZ, USA; University of Arizona, College of Medicine, Tucson, AZ, USA
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Cormican D, Jayaraman AL, Sheu R, Peterson C, Narasimhan S, Shaefi S, Núñez-Gil IJ, Ramakrishna H. Coronary Artery Bypass Grafting Versus Percutaneous Transcatheter Coronary Interventions: Analysis of Outcomes in Myocardial Revascularization. J Cardiothorac Vasc Anesth 2018; 33:2569-2588. [PMID: 30340948 DOI: 10.1053/j.jvca.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Daniel Cormican
- Division of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | | | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Carly Peterson
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Seshasayee Narasimhan
- Department of Cardiology, Manning Base Hospital, Taree, New South Wales, Australia University of Newcastle, Callaghan, New South Wales, Australia; University of New England, Armidale, New South Wales, Australia
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clinico Universitario San Carlos, Madrid, Spain; Cardiovascular Unit, Centro Medico Paris, Pozuelo, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Brilakis ES, Banerjee S, Burke MN. A New Treatment Strategy for Saphenous Vein Graft Lesions? J Am Coll Cardiol 2018; 71:1983-1985. [DOI: 10.1016/j.jacc.2018.03.457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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