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Cheung ES, Zwaan EM, Schreuders TAR, Kofflard MJM, Coert JH, Alings M, IJsselmuiden AJJ, Holtzer CAJ. Treatment and Management of Upper Extremity Dysfunction Following Transradial Percutaneous Coronary Intervention: A Prospective Cohort Study. Hand (N Y) 2024; 19:154-162. [PMID: 35245991 PMCID: PMC10786105 DOI: 10.1177/15589447211073832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transradial artery access is the benchmark approach in transradial percutaneous coronary intervention (TR-PCI). The purpose of this study was to evaluate the different complications, treatments, and outcome of upper extremity dysfunction following a TR-PCI. METHODS This was a prospective cohort substudy of patients with access-site complications. The study population consisted of 433 patients treated with TR-PCI. Referral to the hand center was mandated if the patient experienced new-onset or increase of preexistent symptoms in the upper extremity. Patients were followed up to the last control visit (5-7 months after the index procedure) at the hand center. Outcome results were categorized in "symptom-free," "improvement of symptoms," and "no improvement." RESULTS Forty-one (9% of total) patients underwent assessment at the hand center. Most frequent referral indication was pain in the intervention arm. Women, preexisting sensibility disorder, and osteoarthritis in the intervention arm were associated with increased odds of referral. The most common complications diagnosed were carpal tunnel syndrome (n = 18) and osteoarthritis (n = 15). Thirty patients required further medical treatment. Immobilization therapy was most applied. Seventeen (4% of total) patients had persisting symptoms despite medical treatment. CONCLUSIONS The occurrence of complications in the upper extremity after a TR-PCI is small. Despite medical treatment, symptoms persisted in 4% of all patients treated with TR-PCI. Possible explanations for the persisting symptoms are exacerbation of latent osteoarthritis and carpal tunnel syndrome by trauma-induced edema. Awareness of TR-PCI-induced complications among all specialists is essential to optimize patient care.
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Affiliation(s)
- Elena S. Cheung
- University Medical Center Utrecht, Utrecht, The Netherlands
- Amphia Hospital, Breda, The Netherlands
| | - Eva M. Zwaan
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - J. Henk. Coert
- University Medical Center Utrecht, Utrecht, The Netherlands
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van Ginkel DJ, Bor WL, Dubois CLF, Aarts HM, Rooijakkers MJP, van Bergeijk KH, Rosseel L, Veenstra L, De Backer O, Van Mieghem NM, van der Kley F, Wilgenhof A, Leonora R, Halim J, Schotborgh CE, Barbato E, Van Der Heyden JAS, Frambach P, Ferdinande B, Mylotte D, Fabris E, Rensing BJWM, Timmers L, Swaans MJ, Brouwer J, Nijenhuis VJ, Peper J, Vriesendorp PA, de Laat B, Ninivaggi M, Stragier H, Voskuil M, IJsselmuiden AJJ, Hermanides RS, Agostoni P, van 't Hof AWJ, Wykrzykowska JJ, van Royen N, Delewi R, Ten Berg JM. Periprocedural continuation versus interruption of oral anticoagulant drugs during transcatheter aortic valve implantation: rationale and design of the POPular PAUSE TAVI trial. EUROINTERVENTION 2023; 19:766-771. [PMID: 37605804 PMCID: PMC10654764 DOI: 10.4244/eij-d-23-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
About one-third of patients undergoing transcatheter aortic valve implantation (TAVI) use oral anticoagulants (OAC), mainly due to atrial fibrillation. General guidelines advise interrupting OAC in patients with a high risk of bleeding undergoing interventions. However, preliminary observational data suggest that the continuation of OAC during TAVI is safe and may reduce the risk of periprocedural thromboembolic events. The Periprocedural Continuation Versus Interruption of Oral Anticoagulant Drugs During Transcatheter Aortic Valve Implantation (POPular PAUSE TAVI) is a multicentre, randomised clinical trial with open-label treatment and blinded endpoint assessment. Patients are randomised 1:1 to periprocedural continuation versus interruption of OAC and are stratified for vitamin K antagonist or direct oral anticoagulant use. The primary endpoint is a composite of cardiovascular mortality, all stroke, myocardial infarction, major vascular complications and type 2-4 bleeding within 30 days after TAVI, according to the Valve Academic Research Consortium-3 criteria. Secondary endpoints include separate individual and composite outcomes, quality of life and cost-effectiveness. Since continuation of OAC is associated with the ancillary benefit that it simplifies periprocedural management, the primary outcome is first analysed for non-inferiority; if non-inferiority is proven, superiority will be tested. Recruitment started in November 2020, and the trial will continue until a total of 858 patients have been included and followed for 90 days. In summary, POPular PAUSE TAVI is the first randomised clinical trial to assess the safety and efficacy of periprocedural continuation versus interruption of OAC in patients undergoing TAVI.
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Affiliation(s)
- Dirk Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Willem L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Hugo M Aarts
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees H van Bergeijk
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Hospital Aalst, Aalst, Belgium
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Adriaan Wilgenhof
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Cardiology, Hospital Network Antwerp (ZNA) Middelheim, Antwerp, Belgium
| | - Remigio Leonora
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
| | - Jonathan Halim
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, Onze Lieve Vrouwe Hospital, Aalst, the Netherlands
| | | | - Peter Frambach
- Department of Cardiology, Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg City, Luxembourg
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Benno J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Vincent J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Pieter A Vriesendorp
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bas de Laat
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
| | - Marisa Ninivaggi
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
| | - Hendrik Stragier
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Renicus S Hermanides
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Arnoud W J van 't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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Saada M, Kobo O, Polad J, Halabi M, IJsselmuiden AJJ, Puentes Á, Monségu J, Austin D, Baisebenov RK, Spanó F, Roguin A. Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e-ULTIMASTER registry. Clin Cardiol 2022; 45:1211-1219. [PMID: 36072999 DOI: 10.1002/clc.23902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials. HYOPTHESIS This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI. METHODS The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR). RESULTS There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63). CONCLUSION Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no difference in the incidence of TV-MI or target lesion revascularizations. These findings suggest that PCI for STEMI in elderly patients is relatively safe.
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Affiliation(s)
- Majdi Saada
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Majdi Halabi
- Department of Cardiology, Ziv Hospital, Safed, Israel
| | | | - Ángel Puentes
- Department of Cardiology, San Juan de Dios Hospital, Santiago, Chile
| | - Jacques Monségu
- Department of Cardiology, Groupe Hospitalier Mutualiste, Institut Cardiovasculaire, Grenoble, France
| | - David Austin
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | | | - Fabrizio Spanó
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
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4
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Roleder-Dylewska M, Gasior P, Hommels TM, Roleder T, Berta B, Ang HY, Ng JCK, Hermanides RS, Fabris E, IJsselmuiden AJJ, Kauer F, Alfonso F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Malinowski K, De Luca G, Garcia Garcia HM, Granada JF, Wojakowski W, Kedhi E. Morphological characteristics of lesions with thin cap fibroatheroma—a substudy from the COMBINE (OCT-FFR) trial. Eur Heart J Cardiovasc Imaging 2022; 24:687-693. [PMID: 36342269 DOI: 10.1093/ehjci/jeac218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Aims
To study if any qualitative or quantitative optical coherence tomography (OCT) variables in combination with thin cap fibroatheroma (TCFA) patients could improve the identification of lesions at risk for future major adverse cardiac events (MACEs).
Methods and results
From the combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) trial database (NCT02989740), we performed a detailed assessment OCT qualitative and quantitative variables in TCFA carrying diabetes mellitus (DM) patients with vs. without MACE during follow-up. MACEs were defined as a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, and hospitalization for unstable angina. From the 390 fractional flow reserve (FFR)-negative DM patients, 98 (25.2%) had ≥1 OCT-detected TCFA, of which 13 (13.3%) had MACE and 85 (86.7%) were event-free (non-MACE). The baseline characteristics were similar between both groups; however, a smaller minimal lumen area (MLA) and lower mean FFR value were observed in MACE group (1.80 vs. 2.50 mm2, P = 0.01, and 0.85 vs. 0.89, P = 0.02, respectively). Prevalence of healed plaque (HP) was higher in the MACE group (53.85 vs. 21.18%, P = 0.01). TCFA were predominantly located proximal to the MLA. TCFA area was smaller in the MACE group, while no difference was observed regarding the lesion area.
Conclusion
Within TCFA carrying patients, a smaller MLA, lower FFR values, and TCFA location adjacent to a HP were associated with future MACE. Carpet-like measured lesion area surface was similar, while the TCFA area was smaller in the MACE arm, and predominantly located proximal to the MLA.
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Affiliation(s)
- Magda Roleder-Dylewska
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | | | - Tomasz Roleder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
- Department of Cardiology, Hospital Wroclaw , Wroclaw , Poland
| | - Balasz Berta
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
- Isala Hartcentrum , Zwolle , The Netherlands
| | - Hui Ying Ang
- National Heart Centre Singapore , 5 Hospital Drive, Singapore 169609 , Singapore
- Department of Biomedical Engineering , 4 Engineering Drive 3, Singapore 117583 , Singapore
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore , 5 Hospital Drive, Singapore 169609 , Singapore
- Department of Biomedical Engineering , 4 Engineering Drive 3, Singapore 117583 , Singapore
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste , Trieste , Italy
| | | | - Floris Kauer
- Department of Cardiology, Albert Schweitzer Ziekenhuis , Dordrecht , The Netherlands
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa , Madrid , Spain
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente , Enschede , The Netherlands
- Technical Medical Centre, University of Twente , Enschede , The Netherlands
| | | | - Cyril Camaro
- University Medical Center Radboudumc , Nijmegen , The Netherlands
| | - Mark W Kennedy
- Beaumont Hospital , Dublin , Ireland
- Royal College of Surgeons in Ireland , Dublin , Ireland
| | | | | | - Holger Nef
- Department Cardiology and Angiology, University of Giessen; German Centre for Cardiovascular Research (DZHK) , Gießen , Germany
| | | | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College , Kraków , Poland
| | | | | | - Juan F Granada
- Cardiovascular Research Foundation , New York , USA
- Columbia University Medical Center NYC , NY , USA
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
- Erasmus Hospital, Université libre de Bruxelles (ULB) , Rte de Lennik 808, 1070 Bruxelles , Belgium
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5
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Kobo O, Saada M, von Birgelen C, Tonino PAL, Íñiguez-Romo A, Fröbert O, Halabi M, Oemrawsingh RM, Polad J, IJsselmuiden AJJ, Roffi M, Aminian A, Mamas MA, Roguin A. Impact of Multisite artery disease on Clinical Outcomes After Percutaneous Coronary Intervention: An Analysis from the e-Ultimaster Registry. Eur Heart J Qual Care Clin Outcomes 2022:qcac043. [PMID: 35876646 DOI: 10.1093/ehjqcco/qcac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND multisite artery disease is considered a 'malignant' type of atherosclerotic disease associated with an increased cardiovascular risk, but the impact of multisite artery disease on clinical outcomes after percutaneous coronary intervention (PCI) is unknown. METHODS Patients enrolled in the large, prospective e-Ultimaster study were grouped into 1) those without known prior vascular disease; 2) those with known single-territory vascular disease 3) those with known 2-3 territories (i.e, coronary, cerebrovascular, or peripheral) vascular disease (multisite artery disease). The primary outcome was coronary target lesion failure (TLF) defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 1-year. Inverse propensity score weighted (IPSW) analysis was performed to address differences in baseline patient and lesion characteristics. RESULTS Of the 37,198 patients included in the study, 62.3% had no prior known vascular disease, 32.6% had single-territory vascular disease, and 5.1% multisite artery disease. Patients with known vascular disease were older and were more likely to be men and to have more co-morbidities. After IPSW, the TLF rate incrementally increased with the number of diseased vascular beds (3.16%, 4.44% and 6.42% for no, single- and multisite artery disease, p<0.01 for all comparisons). This was also true for all cause death (2.22%, 3.28% and 5.29%, p<0.01 for all comparisons) and cardiac mortality (1.26%, 1.91% and 3.62%, p≤0.01 for all comparisons). CONCLUSIONS Patients with previously known vascular disease experienced an increased risk for adverse cardiovascular events and mortality post percutaneous coronary intervention. This risk is highest among patients with multisite artery disease.Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02188355.
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Affiliation(s)
- Ofer Kobo
- Hillel Yaffe Medical Center, Technion - Faculty of Medicine, Israel
| | - Majdi Saada
- Hillel Yaffe Medical Center, Technion - Faculty of Medicine, Israel
| | | | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | | | - Jawed Polad
- Jeroen Bosch Ziekenhuis, 's Hertogenbosch, Netherlands
| | | | - Marco Roffi
- Division of Cardiology, University Hospitals, Geneva, Switzerland
| | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Technion - Faculty of Medicine, Israel
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6
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Fabris E, Berta B, Roleder T, Hermanides RS, IJsselmuiden AJJ, Kauer F, Alfonso F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Roleder-Dylewska M, Gasior P, Malinowski K, De Luca G, Garcia-Garcia HM, Granada JF, Wojakowski W, Kedhi E. Thin-Cap Fibroatheroma Rather Than Any Lipid Plaques Increases the Risk of Cardiovascular Events in Diabetic Patients: Insights From the COMBINE OCT-FFR Trial. Circ Cardiovasc Interv 2022; 15:e011728. [PMID: 35485232 DOI: 10.1161/circinterventions.121.011728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Autopsy studies have established that thin-cap fibroatheromas (TCFAs) are the most frequent cause of fatal coronary events. In living patients, optical coherence tomography (OCT) has sufficient resolution to accurately differentiate TCFA from thick-cap fibroatheroma (ThCFA) and not lipid rich plaque (non-LRP). However, the impact of OCT-detected plaque phenotype of nonischemic lesions on future adverse events remains unknown. Therefore, we studied the natural history of OCT-detected TCFA, ThCFA, and non-LRP in patients enrolled in the prospective multicenter COMBINE FFR-OCT trial (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients). METHODS In the COMBINE FFR-OCT trial, patients with diabetes and ≥1 lesion with a fractional flow reserve >0.80 underwent OCT evaluation and were clinically followed for 18 months. A composite primary end point of cardiac death, target vessel-related myocardial infarction, target-lesion revascularization, and hospitalization for unstable angina was evaluated in relation to OCT-based plaque morphology. RESULTS A total of 390 patients (age 67.5±9 years; 63% male) with ≥1 nonischemic lesions underwent OCT evaluation: 284 (73%) had ≥1 LRP and 106 (27%) non-LRP lesions. Among LRP patients, 98 (34.5%) had ≥1 TCFA. The primary end point occurred in 7% of LRP patients compared with 1.9% of non-LRP patients (7.0% versus 1.9%; hazard ratio [HR], 3.9 [95% CI, 0.9-16.5]; P=0.068; log rank-P=0.049). However, within LRP patients, TCFA patients had a much higher risk for primary end point compared with ThCFA (13.3% versus 3.8%; HR, 3.8 [95% CI, 1.5-9.5]; P<0.01), and to non-LRP patients (13.3% versus 1.9%; HR, 7.7 [95% CI, 1.7-33.9]; P<0.01), whereas ThCFA patients had risk similar to non-LRP patients (3.8% versus 1.9%; HR, 2.0 [95% CI, 0.42-9.7]; P=0.38). Multivariable analyses identified TCFA as the strongest independent predictor of primary end point (HR, 6.79 [95% CI, 1.50-30.72]; P=0.013). CONCLUSIONS Among diabetes patients with fractional flow reserve-negative lesions, patients carrying TCFA lesions represent only one-third of LRP patients and are associated with a high risk of future events while patients carrying LRP-ThCFA and non-LRP lesions portend benign outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02989740.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Italy (E.F.)
| | - Balasz Berta
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.B.).,Isala Hartcentrum, Zwolle, the Netherlands (B.B., R.S.H.)
| | - Tomasz Roleder
- Department of Cardiology, Hospital Wroclaw, Poland (T.R.)
| | | | | | - Floris Kauer
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands (F.K.)
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain (F.A.)
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands (C.v.B.).,Technical Medical Centre, Health Technology and Services Research, University of Twente, Enschede, Netherlands (C.v.B.)
| | | | - Cyril Camaro
- University Medical Center Radboudumc, Nijmegen, the Netherlands (C.C.)
| | | | | | - Michael Magro
- Tweesteden Ziekenhuis, Tilburg, the Netherlands (M.M.)
| | - Holger Nef
- Universitätsklinikum, Gießen/Marburg, Germany (H.N.)
| | | | | | - Pawel Gasior
- Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)
| | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland (K.M.)
| | | | - Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C. (H.M.G.-G.)
| | - Juan F Granada
- Cardiovascular Research Foundation, New York (J.F.G.).,Columbia University Medical Center NYC, NY (J.F.G.)
| | - Wojciech Wojakowski
- Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)
| | - Elvin Kedhi
- Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.).,Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium (E.K.)
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7
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Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022; 351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India). METHODS Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared. RESULTS A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval. CONCLUSIONS After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.
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Affiliation(s)
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Redondo
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Ana Serrador
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
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García-Gómez M, Delgado-Arana JR, Halim J, De Marco F, Trani C, Martin P, Won-Keun K, Montorfano M, den Heijer P, Bedogni F, Sardella G, IJsselmuiden AJJ, Campante Teles R, Aristizabal-Duque CH, Gordillo X, Santos-Martinez S, Barrero A, Gómez-Salvador I, Ancona M, Redondo A, Román JAS, Amat-Santos IJ. Next-generation balloon-expandable Myval transcatheter heart valve in low-risk aortic stenosis patients. Catheter Cardiovasc Interv 2021; 99:889-895. [PMID: 34390296 DOI: 10.1002/ccd.29923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to describe hemodynamic performance and clinical outcomes at 30-day follow-up of the balloon-expandable (BE) Myval transcatheter heart valve (THV) in low-risk patients. BACKGROUND The results of the next-generation BE Myval THV in low-risk aortic stenosis (AS) patients are still unknown. METHODS Retrospective registry performed in nine European centers including patients with low predicted operative mortality risk according to Society of thoracic surgeons (STS) and European system for cardiac operative risk evaluation (EuroSCORE-II) scores. RESULTS Between September 2019 and February 2021, a total of 100 patients (51% males, mean age 80 ± 6.5 years) were included. Mean STS score and EuroSCORE-II were 2.4 ± 0.8% and 2.2 ± 0.7%, respectively. Intermediate sizes were used in 39% (21.5 mm: 8%, 24.5 mm: 15%, 27.5 mm: 15%). There were no cases of valve embolization, coronary artery occlusion, annulus rupture, or procedural death. A definitive pacemaker implantation was needed in eight patients (8%). At 30-day follow-up aortic valve area (0.7 ± 0.2 vs. 2.1 ± 0.6 cm2 ) and mean aortic valve gradient (43.4 ± 11.1 vs. 9.0 ± 3.7 mmHg) improved significantly (p < 0.001). Moderate aortic regurgitation occurred in 4%. Endpoints of early safety and clinical efficacy were 3 and 1%, respectively. CONCLUSIONS Hemodynamic performance and 30-day clinical outcomes of the BE Myval THV in low-risk AS patients were favorable. Longer-term follow-up is warranted.
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Affiliation(s)
- Mario García-Gómez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jose Raúl Delgado-Arana
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | - Carlo Trani
- Cardiology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pedro Martin
- Cardiology Department, Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | - Kim Won-Keun
- Cardiology Department, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Matteo Montorfano
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter den Heijer
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | | | | | | | | | - Ximena Gordillo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Sandra Santos-Martinez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Barrero
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Gómez-Salvador
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Marco Ancona
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alfredo Redondo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
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9
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Kedhi E, Berta B, Roleder T, Hermanides RS, Fabris E, IJsselmuiden AJJ, Kauer F, Alfonso F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Al Nooryani A, Rivero F, Malinowski K, De Luca G, Garcia Garcia H, Granada JF, Wojakowski W. Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial. Eur Heart J 2021; 42:4671-4679. [PMID: 34345911 DOI: 10.1093/eurheartj/ehab433] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/12/2021] [Accepted: 06/25/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions. METHODS AND RESULTS COMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99-10.89; P < 0.001). The Cox regression multivariable analysis identified TCFA as the strongest predictor of major adverse clinical events (MACE) (hazard ratio 5.12; 95% confidence interval 2.12-12.34; P < 0.001). CONCLUSIONS Among DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients.
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Affiliation(s)
- Elvin Kedhi
- Erasmus Hospital, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.,Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45, 40-635, Katowice, Poland
| | - Balazs Berta
- Heart and Vascular Center, Semmelweis University, Gaál József út 9, 1122 Budapest, Hungary.,Isala Hartcentrum, Dokter van Heesweg 2 8025 AB, Zwolle, the Netherlands
| | - Tomasz Roleder
- Regional Specialist Hospital, Kamieńskiego 73A, 51-124 Wrocław, Poland
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste, Italy
| | | | - Floris Kauer
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands.,Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Cyril Camaro
- University Medical Center Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Mark W Kennedy
- Beaumont Hospital, Beaumont Rd, Beaumont, Dublin, Ireland
| | - Bruno Pereira
- INCCI-Haertz Zenter, 2 A Rue Nicolas Ernest Barblé, 1210 Luxembourg, Luxembourg
| | - Michael Magro
- Tweesteden Ziekenhuis, Doctor Deelenlaan 5, 5042 AD Tilburg, the Netherlands
| | - Holger Nef
- Universitätsklinikum, Gießen/Marburg, Klinikstraße 33, 35392 Gießen, Germany
| | | | - Arif Al Nooryani
- Al Qassimi Hospital - Wasit St - MughaidirSuburbAlKhezamiaSharjah, United Arab Emirates
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Krzysztof Malinowski
- Krakow Cardiovascular Research Institute (KCRI), B, Miechowska 5, 30-055 Krakow, Poland.,Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Krakow, Poland
| | - Giuseppe De Luca
- AziendaOspedaliera-Universitaria "Maggiore dellaCarità", Eastern Piedmont University, Corso Giuseppe Mazzini, 18, 28100 Novara, Italy
| | - Hector Garcia Garcia
- MedStar Washington Hospital Center, 110 Irving St., NW Washington, DC 20010, USA
| | - Juan F Granada
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA.,Columbia University Medical Center NYC, 622 W 168th St, New York, NY 10032, USA
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45, 40-635, Katowice, Poland
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Simsek C, Schölzel BE, den Heijer P, Vos J, Meuwissen M, van den Branden B, IJsselmuiden AJJ. The rationale of using cerebral embolic protection devices during transcatheter aortic valve implantation. Neth Heart J 2020; 28:249-252. [PMID: 32152782 PMCID: PMC7190763 DOI: 10.1007/s12471-020-01380-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aortic valve stenosis is one of the most common valvular abnormalities, which can manifest as angina, syncope, dyspnoea and sudden cardiac death. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical valve replacement in patients with severe aortic valve stenosis, resulting in less morbidity, shorter time to recovery and similar mortality rates. Progress in this field has reduced complication rates. However, the incidence of peri-procedural stroke remains relatively high (around 4%). To fully utilise the potential of TAVI, cerebral embolic protection devices (CEPD) have been developed and introduced. In this position paper, we aim to summarise the available data on several CEPD.
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Affiliation(s)
- C Simsek
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - B E Schölzel
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
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Vlieger S, Simsek C, de Jong-Salentijn EM, Bouchez D, Weevers APJD, Oemrawsingh RM, IJsselmuiden AJJ. Increase in Coronary Lumen Area and Stent Apposition After Treatment of CTO Using a Coronary Self-Expanding Stent. JACC Cardiovasc Interv 2020; 13:537-539. [PMID: 32081248 DOI: 10.1016/j.jcin.2019.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
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Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. The 1‑year safety and efficacy outcomes of Absorb bioresorbable vascular scaffolds for coronary artery disease treatment in diabetes mellitus patients: the ABSORB DM Benelux study. Neth Heart J 2019; 27:541-549. [PMID: 31197750 PMCID: PMC6823340 DOI: 10.1007/s12471-019-1293-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Diabetes mellitus (DM) patients show higher rates of repeat revascularisation even in the era of modern drug-eluting stents (DES). The concept of bioresorbable scaffolds is becoming captivating, as it might allow for repeat interventions, prolonging the time span during which patients can be treated by percutaneous coronary intervention (PCI). Aims We intend to evaluate the short- and long-term safety and efficacy of Absorb bioresorbable vascular scaffolds (Absorb BVS) in the treatment of coronary artery disease (CAD) in DM patients for any indication. Methods The ABSORB DM Benelux is an international prospective study in DM patients who have undergone PCI with ≥1 Absorb BVS. Major adverse cardiac events (MACE) at 1 year was the primary endpoint, defined as a composite of all-cause death, any myocardial infarction (MI) and ischaemia-driven target vessel revascularisation (TVR). Secondary endpoints were target lesion failure (TLF) and definite or probable scaffold thrombosis (ScT). Results Between April 2015 and March 2017, 150 DM patients and 188 non-complex lesions were treated. Device implantation was successful in 100%. MACE occurred in 14 (9.5%) patients, with all-cause death occurring in 4 (2.7%), any MI in 6 (4.1%) and ischaemia-driven TVR in 7 (4.8%) respectively. TLF was reported in 11 (7.5%). Definite and probable ScT was observed in 2 (1.4%). Conclusion Absorb BVS for treatment of anatomically low-risk patients with DM show acceptable safety and efficacy outcomes at 1 year. If these promising results are confirmed after a longer follow-up period, new-generation bioresorbable scaffolds combined with refinement of implantation techniques might open new horizons for CAD treatment in DM patients. Electronic supplementary material The online version of this article (10.1007/s12471-019-1293-7) contains supplementary material, which is available to authorised users.
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Affiliation(s)
| | | | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Zwolle, The Netherlands
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13
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Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. Everolimus-eluting bioresorbable scaffolds for treatment of coronary artery disease in patients with diabetes mellitus: the midterm follow-up of the prospective ABSORB DM Benelux study. Cardiovasc Diabetol 2019; 18:25. [PMID: 30851731 PMCID: PMC6408833 DOI: 10.1186/s12933-019-0827-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains challenging even with modern drug-eluting stents (DES) due to high rates of repeat revascularization. Everolimus-eluting bioresorbable scaffolds (EE-BRS) might allow for repeat intervention prolonging the time interval of percutaneous treatment options. Methods The ABSORB DM Benelux Study is a dedicated prospective, international study to evaluate the midterm safety and efficacy of EE-BRS in DM patients. All DM patients that received ≥ 1 EE-BRS for any indication were enrolled and prospectively followed. Study endpoints were major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction (MI) and ischemic-driven target vessel revascularization (TVR); target lesion failure (TLF): a composite of cardiac death (CD), target vessel MI, and ischemic-driven target lesion revascularization (TLR), as well as definite or probable scaffold thrombosis (ScT). Results Between April 2015 till March 2017, 150 DM patients and 188 lesions were treated and followed up to 3 years. Device implantation success was 100%. MACE occurred in 15.2% (event rate of 8.8 per 100 PY). TLF was reported in 11.7% (7.0 events per 100 PY). CD, target vessel MI, ischemic-driven TLR occurred in 3.4%, 3.6% and 5.5% respectively, while ScT was observed in 1.4%. There were no occurrences of late or very late ScT. Conclusion EE-BRS treatment in DM patients shows comparable midterm safety and efficacy outcomes when historically compared with modern DES. New-generation EE-BRS might offer an attractive alternative to metallic DES in treatment of fast progressing atherosclerosis population as in DM patients. Trial registration NTR5447. Registered 05 October 2015, retrospectively registered
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Affiliation(s)
- T M Hommels
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - R S Hermanides
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,, Dokter van Heesweg 2, Postbus 10400, 8000 GK, Zwolle, The Netherlands.
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14
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Zwaan EM, IJsselmuiden AJJ, van Rosmalen J, van Geuns RJM, Amoroso G, Moerman E, Ritt MJPF, Schreuders TAR, Kofflard MJM, Holtzer CAJ. Rationale and design of the ARCUS: Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function. Catheter Cardiovasc Interv 2016; 88:1036-1043. [PMID: 27037641 DOI: 10.1002/ccd.26525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/05/2016] [Accepted: 02/27/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study is to provide a complete insight in the access-site morbidity and upper extremity function after Transradial Percutaneous Coronary Intervention (TR-PCI). BACKGROUND In percutaneous coronary intervention the Transradial Approach (TRA) is gaining popularity as a default technique. It is a very promising technique with respect to post-procedure complications, but the exact effects of TRA on upper extremity function are unknown. METHODS AND RESULTS The effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) trial is a multicenter prospective cohort study that will be conducted in all patients admitted for TR-PCI. Clinical outcomes will be monitored during a follow-up of 6 months, with its primary endpoint at two weeks of follow-up. To investigate the complete upper extremity function, a combination of physical examinations and validated questionnaires will be used to provide information on anatomical integrity, strength, range of motion (ROM), coordination, sensibility, pain, and functioning in everyday life. Procedural and material specifications will be registered in order to include all possible aspects influencing upper extremity function. CONCLUSIONS Results from this study will elucidate the effect of TR-PCI on upper extremity function. This creates the opportunity to further optimize TR-PCI, to make improvements in functional outcome and to prevent morbidity regarding full upper extremity function. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Eva M Zwaan
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Giovanni Amoroso
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Esther Moerman
- Department of Plastic, Reconstructive, and Hand Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Marcel J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Carlo A J Holtzer
- Department of Plastic, Reconstructive, and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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de Mulder M, Hendriksz TR, de Jong PL, IJsselmuiden AJJ. A curly case: dissecting giant arteriovenous anomaly - left main coronary artery shunting to superior vena cava. EUROINTERVENTION 2015; 11:e1. [PMID: 26499049 DOI: 10.4244/eijv11i6a132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Maarten de Mulder
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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16
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IJsselmuiden AJJ, Cotton JM, Slagboom T, van der Wieken R, Kiemeneij F, Serruys PW, Laarman G. Safe and effective direct implantation of a new stent through 5 F. guiding catheters with delivery from the radial artery: initial results of a prospective registry. Int J Cardiovasc Intervent 2003; 5:72-6. [PMID: 12745862 DOI: 10.1080/14628840310003253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the direct implantation of a new stent via the radial artery through a 5 F. guiding catheter. Background advances in the design of stents and stent delivery systems have facilitated the performance of direct stenting and the use of thinner guiding catheters. METHODS This registry enrolled prospectively 125 patients (147 lesions, 20.4% AHA/ACC class B2/C) who underwent elective percutaneous coronary revascularization procedures for stable or unstable angina between November 2000 and March 2001. RESULTS Cannulation of the radial artery was attempted in 92.7% and was successful in 91.0% of cases. Direct stenting was successful in 88.7% of lesions and procedural success was 99.3%. In-hospital major adverse cardiac events occurred in 1.6% of cases (one death, one semi-urgent coronary artery bypass operation). The final rate of successful stent implantation through 5 F. guiding catheters was 96.7%. There were no access-site-related complications. Failure to cross the lesion occurred in 10% of attempts. At a mean follow-up of 7 +/- 2.8 months after discharge from hospital, 79% of patients had remained free of angina, and 89% had remained free of ischemic events. CONCLUSIONS Direct stenting with a new stent design was safe, effective, and could be accomplished through 5 F. guiding catheters with favorable long-term clinical outcomes.
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IJsselmuiden AJJ, Serruys PW, Scholte A, Kiemeneij F, Slagboom T, vd Wieken LR, Tangelder GJ, Laarman GJ. Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events: six month results of a randomized trial. Eur Heart J 2003; 24:421-9. [PMID: 12633544 DOI: 10.1016/s0195-668x(02)00701-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
STUDY OBJECTIVE To compare the long-term angiographic, clinical and economic outcome of direct stenting vs stenting after balloon predilatation. PATIENT POPULATION AND METHODS Four hundred patients with coronary stenoses in a single native vessel were randomized to direct stenting vs stenting after predilatation. A major adverse cardiac and cerebral event (MACCE) was defined as death, myocardial infarction, stent thrombosis, target restenosis, repeat target- and non-target vessel-related percutaneous coronary intervention, target lesion revascularization, coronary artery bypass surgery and stroke. RESULTS Stents were successfully implanted in 98.3% of patients randomized to direct stenting vs 97.8% randomized to stenting preceded by predilatation. The primary success rate of direct stenting was 88.3%, vs 97.8% for stenting preceded by balloon dilatation (P=0.01). The angiographic follow-up at 6 months included 333 of the 400 patients (83%). The binary in-stent restenosis rate was 23.1% of 163 patients randomized to direct stenting vs 18.8% of 166 patients randomized to balloon predilatation (P=0.32). By 185+/-25 days, MACCE had occurred in 31 of 200 (15.5%) patients randomized to direct stenting, vs 33 of 200 (16.5%) randomized to predilatation (P=0.89). At 6 months, costs associated with the direct stenting strategy (Euros 3222/patient) were similar to those associated with predilatation (Euros 3428/patient, P=0.43). However, procedural costs were significantly lower. It is noteworthy that, on multivariate analysis, a baseline C-reactive protein level >10 mg l(-1)was a predictor of restenosis (odds ratio: 2.10, P=0.025) as well as of MACCE (odds ratio: 1.94, P=0.045). CONCLUSIONS Compared to stenting preceded by balloon predilatation, direct stenting was associated with similar 6-month restenosis and MACCE rates. Procedural, but not overall 6-month costs, were reduced by direct stenting. An increased baseline CRP level was an independent predictor of adverse long-term outcome after coronary stent implantation.
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Affiliation(s)
- A J J IJsselmuiden
- Amsterdam Department of Interventional Cardiology, OLVG-Hospital, 1(e) Oosterparkstraat 279,1090 HM, Amsterdam, The Netherlands.
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