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Wang A, Xie X, Tian X, Johnston SC, Li H, Bath PM, Zuo Y, Jing J, Lin J, Wang Y, Zhao X, Li Z, Jiang Y, Liu L, Meng X, Wang Y. Ticagrelor-Aspirin Versus Clopidogrel-Aspirin Among CYP2C19 Loss-of-Function Carriers With Minor Stroke or Transient Ischemic Attack in Relation to Renal Function: A Post Hoc Analysis of the CHANCE-2 Trial. Ann Intern Med 2022; 175:1534-1542. [PMID: 36315949 DOI: 10.7326/m22-1667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence on the risk-benefit ratio of dual antiplatelet therapies among patients with stroke and impaired renal function is limited and inconsistent. OBJECTIVE To investigate the effect of renal function on the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin treatment. DESIGN Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT04078737). SETTING 202 centers in China. PATIENTS CYP2C19 loss-of-function allele carriers with minor stroke or transient ischemic attack. INTERVENTION Ticagrelor-aspirin and clopidogrel-aspirin. MEASUREMENTS Renal function was evaluated by estimated glomerular filtration rate (eGFR) levels. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days, respectively. RESULTS Among 6378 patients, 4050 (63.5%) had normal (eGFR ≥90 mL/min/1.73 m2), 2010 (31.5%) had mildly decreased (eGFR 60 to 89 mL/min/1.73 m2), and 318 (5.0%) had moderately to severely decreased (eGFR <60 mL/min/1.73 m2) renal function. The corresponding differences in recurrent stroke between ticagrelor-aspirin and clopidogrel-aspirin for normal, mildly decreased, and moderately to severely decreased renal function was -2.8 percentage points (95% CI, -4.4 to -1.3 percentage points) (hazard ratio [HR], 0.63 [CI, 0.49 to 0.81]), -0.2 percentage point (CI, -2.4 to 2.0 percentage points) (HR, 0.98 [CI, 0.69 to 1.39]), and 3.7 percentage points (CI, -2.3 to 10.1 percentage points) (HR, 1.31 [CI, 0.48 to 3.55]), respectively. Rates of severe or moderate bleeding did not substantially differ by treatment assignments across eGFR categories. LIMITATION Renal function was only evaluated by using eGFR, and the proportion of patients with severely decreased renal function was low. CONCLUSION Patients with normal, rather than impaired, renal function received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin. PRIMARY FUNDING SOURCE Ministry of Science and Technology of the People's Republic of China.
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China National Clinical Research Center for Neurological Diseases, Beijing, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China (X.T., Y.Z.)
| | | | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Yingting Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China National Clinical Research Center for Neurological Diseases, Beijing, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China (X.T., Y.Z.)
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, and China National Clinical Research Center for Neurological Diseases, Beijing, China (A.W., X.X., H.L., J.J., J.L., Y.W., X.Z., Z.L., Y.J., L.L., X.M.)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China National Clinical Research Center for Neurological Diseases, Beijing, and Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W.)
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Baber U, Li SX, Pinnelas R, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv 2019; 11:e006144. [PMID: 29870385 DOI: 10.1161/circinterventions.117.006144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
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Affiliation(s)
- Usman Baber
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Shawn X Li
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Rebecca Pinnelas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Stuart J Pocock
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Mitchell W Krucoff
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Cono Ariti
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - C Michael Gibson
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Philippe Gabriel Steg
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Giora Weisz
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Bernhard Witzenbichler
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Timothy D Henry
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Annapoorna S Kini
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Thomas Stuckey
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Cohen
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Ioannis Iakovou
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - George Dangas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Melissa B Aquino
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Samantha Sartori
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Alaide Chieffo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Moliterno
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Antonio Colombo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Roxana Mehran
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.).
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