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Elscot JJ, Kakar H, Scarparo P, den Dekker WK, Bennett J, Schotborgh CE, van der Schaaf R, Sabaté M, Moreno R, Ameloot K, van Bommel RJ, Forlani D, Van Reet B, Esposito G, Dirksen MT, Ruifrok WPT, Everaert BRC, Van Mieghem C, Pinar E, Alfonso F, Cummins P, Lenzen M, Brugaletta S, Daemen J, Boersma E, Van Mieghem NM, Diletti R. Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome. JACC Cardiovasc Interv 2024; 17:771-782. [PMID: 38538172 DOI: 10.1016/j.jcin.2024.01.278] [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] [Received: 09/05/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Complete revascularization of the culprit and all significant nonculprit lesions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear. OBJECTIVES This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. METHODS This prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year. RESULTS The BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: -1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018). CONCLUSIONS ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.
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Affiliation(s)
- Jacob J Elscot
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hala Kakar
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paola Scarparo
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wijnand K den Dekker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | | | - René van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos, Belgium
| | | | - Daniele Forlani
- Department of Cardiology, Santo Spirito Hospital, Pescara, Italy
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout, Turnhout, Belgium
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurits T Dirksen
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | | | | | - Eduardo Pinar
- Department of Cardiology, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Paul Cummins
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mattie Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Diletti R, den Dekker WK, Bennett J, Schotborgh CE, van der Schaaf R, Sabaté M, Moreno R, Ameloot K, van Bommel R, Forlani D, van Reet B, Esposito G, Dirksen MT, Ruifrok WPT, Everaert BRC, Van Mieghem C, Elscot JJ, Cummins P, Lenzen M, Brugaletta S, Boersma E, Van Mieghem NM. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet 2023; 401:1172-1182. [PMID: 36889333 DOI: 10.1016/s0140-6736(23)00351-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [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: 01/28/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND In patients with acute coronary syndrome and multivessel coronary disease, complete revascularisation by percutaneous coronary intervention (PCI) is associated with improved clinical outcomes. We aimed to investigate whether PCI for non-culprit lesions should be attempted during the index procedure or staged. METHODS This prospective, open-label, non-inferiority, randomised trial was done at 29 hospitals across Belgium, Italy, the Netherlands, and Spain. We included patients aged 18-85 years presenting with ST-segment elevation myocardial infarction or non-ST-segment elevation acute coronary syndrome and multivessel (ie, two or more coronary arteries with a diameter of 2·5 mm or more and ≥70% stenosis based on visual estimation or positive coronary physiology testing) coronary artery disease with a clearly identifiable culprit lesion. A web-based randomisation module was used to randomly assign patients (1:1), with a random block size of four to eight, stratified by study centre, to undergo immediate complete revascularisation (PCI of the culprit lesion first, followed by other non-culprit lesions deemed to be clinically significant by the operator during the index procedure) or staged complete revascularisation (PCI of only the culprit lesion during the index procedure and PCI of all non-culprit lesions deemed to be clinically significant by the operator within 6 weeks after the index procedure). The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1 year after the index procedure. Secondary outcomes included all-cause mortality, myocardial infarction, and unplanned ischaemia-driven revascularisation at 1 year after the index procedure. Primary and secondary outcomes were assessed in all randomly assigned patients by intention to treat. Non-inferiority of immediate to staged complete revascularisation was considered to be met if the upper boundary of the 95% CI of the hazard ratio (HR) for the primary outcome did not exceed 1·39. This trial is registered with ClinicalTrials.gov, NCT03621501. FINDINGS Between June 26, 2018, and Oct 21, 2021, 764 patients (median age 65·7 years [IQR 57·2-72·9] and 598 [78·3%] males) were randomly assigned to the immediate complete revascularisation group and 761 patients (median age 65·3 years [58·6-72·9] and 589 [77·4%] males) were randomly assigned to the staged complete revascularisation group, and were included in the intention-to-treat population. The primary outcome at 1 year occurred in 57 (7·6%) of 764 patients in the immediate complete revascularisation group and in 71 (9·4%) of 761 patients in the staged complete revascularisation group (HR 0·78, 95% CI 0·55-1·11, pnon-inferiority=0·0011). There was no difference in all-cause death between the immediate and staged complete revascularisation groups (14 [1·9%] vs nine [1·2%]; HR 1·56, 95% CI 0·68-3·61, p=0·30). Myocardial infarction occurred in 14 (1·9%) patients in the immediate complete revascularisation group and in 34 (4·5%) patients in the staged complete revascularisation group (HR 0·41, 95% CI 0·22-0·76, p=0·0045). More unplanned ischaemia-driven revascularisations were performed in the staged complete revascularisation group than in the immediate complete revascularisation group (50 [6·7%] patients vs 31 [4·2%] patients; HR 0·61, 95% CI 0·39-0·95, p=0·030). INTERPRETATION In patients presenting with acute coronary syndrome and multivessel disease, immediate complete revascularisation was non-inferior to staged complete revascularisation for the primary composite outcome and was associated with a reduction in myocardial infarction and unplanned ischaemia-driven revascularisation. FUNDING Erasmus University Medical Center and Biotronik.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Wijnand K den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | | | - Rene van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Manel Sabaté
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos, Genk, Belgium
| | | | - Daniele Forlani
- Department of Cardiology, Santo Spirito Hospital, Pescara, Italy
| | - Bert van Reet
- Department of Cardiology, AZ Turnhout, Turnhout, Belgium
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurits T Dirksen
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | | | | | | | - Jacob J Elscot
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paul Cummins
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mattie Lenzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Salvatore Brugaletta
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Eric Boersma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
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Logghe Y, Van Hoe L, Vanhoenacker P, Bladt O, Simons P, Kersschot E, Van Mieghem C. Clinical impact of CT coronary angiography without exclusion of small coronary artery segments: a real-world and long-term study. Open Heart 2020; 7:openhrt-2019-001222. [PMID: 32385115 PMCID: PMC7228654 DOI: 10.1136/openhrt-2019-001222] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES CT coronary angiography (CTCA) has become a valuable diagnostic test in the workup of patients with possible coronary artery disease (CAD). Because of inherent limitations in spatial resolution, epicardial vessels with a small diameter, in general less than 1.5-2 mm, have so far been excluded in studies assessing clinical utility of CTCA. This study sought to assess the clinical impact of CTCA taking into account pathology in small coronary arteries. METHODS We conducted a retrospective cohort study of all patients with possible CAD who underwent dual-source CTCA and subsequent invasive coronary angiography (ICA) between January 2010 and July 2017. Patients with an Agatston calcium score ≥1000 were reported separately. Diagnostic accuracy of CTCA on a patient, vessel and segment level was calculated. The physician's therapeutic decision was defined as conservative, medical antianginal treatment or revascularisation. Using ICA as the reference, we calculated the precision of CTCA to replicate these therapeutic recommendations. RESULTS In total, 1209 patients underwent both CTCA and ICA. Overall diagnostic performance of CTCA showed a sensitivity of 90% (95% CI 86% to 93%) and specificity of 40% (95% CI 36% to 45%). With regard to clinical decision making, CTCA showed good performance: 91% of patients who were treated medically or by revascularisation were correctly identified. Prevalence of disease in small vessel segments was low: 16% showed significant CAD on ICA. Prevalence of significant disease was 70% in patients with an Agatston score ≥1000: the majority underwent revascularisation. CONCLUSIONS From a true patient perspective, without exclusion of smaller coronary artery segments, CTCA allows safe patient management.
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Affiliation(s)
- Yannick Logghe
- Anesthesiology, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Lieven Van Hoe
- Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
| | - Piet Vanhoenacker
- Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
| | - Olivier Bladt
- Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
| | - Philip Simons
- Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
| | - Erik Kersschot
- Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
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4
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Toth GG, De Bruyne B, Kala P, Ribichini FL, Casselman F, Ramos R, Piroth Z, Fournier S, Piccoli A, Van Mieghem C, Penicka M, Mates M, Nemec P, Van Praet F, Stockman B, Degriek I, Barbato E. Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting: the GRAFFITI trial. EUROINTERVENTION 2019; 15:e999-e1005. [DOI: 10.4244/eij-d-19-00463] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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De Mey N, Cammu G, Brandt I, Belmans A, Van Mieghem C, Foubert L, De Decker K. High-sensitivity cardiac troponin release after conventional and minimally invasive cardiac surgery. Anaesth Intensive Care 2019; 47:255-266. [DOI: 10.1177/0310057x19845377] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After cardiac surgery, a certain degree of myocardial injury is common. The arbitrarily proposed biomarker cut-off point in the Third Universal Definition for diagnosing coronary artery bypass grafting (CABG)–related perioperative myocardial infarction (PMI) is controversial and unvalidated for non-CABG surgery. Minimally invasive cardiac surgery is often thought to be associated with less myocardial damage compared to conventional surgical approaches. We conducted a real-life prospective study with serial sampling of high-sensitivity cardiac troponin T (hs-cTnT) in patients undergoing conventional and minimally invasive cardiac surgery. Four different types of cardiac surgery were performed in 400 patients (February 2014–January 2015): CABG, aortic valve replacement, minimally invasive mitral/tricuspid valve surgery through the HeartPort (HP) technique and combined CABG/valve surgery. Each group was further subdivided for comparison between the different surgical techniques. Blood samples were collected consecutively at intensive care unit (ICU) admission and 3, 6, 9, 12, 18, 24 and 48 h thereafter. The hs-cTnT values by peak timepoint differed significantly depending on the surgical approach. The overall peak timepoint for hs-cTnT occurred 6 h after ICU admission. The combined surgery and multiple-valve HP groups had the highest values (medians of 1067.5 (744.9–1455) ng/L and 1166 (743.7–2470) ng/L, respectively). The peak hs-cTnT values for patients developing PMI showed high variability. Differentiation between cardiac surgery–related necrosis and PMI remains challenging. This study emphasizes the importance of a clinically reliable biomarker cut-off value in addition to electrocardiography and echocardiography to optimize PMI diagnosis.
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Affiliation(s)
- Nathalie De Mey
- Departments of Anaesthesia and Critical Care Medicine, OLV Hospital, Aalst, Belgium
| | - Guy Cammu
- Departments of Anaesthesia and Critical Care Medicine, OLV Hospital, Aalst, Belgium
| | - Inger Brandt
- Department of Clinical Chemistry, OLV Hospital, Aalst, Belgium
| | - Ann Belmans
- Department of I-BioStat, University Hospital of Leuven and Hasselt, Leuven, Belgium
| | | | - Luc Foubert
- Departments of Anaesthesia and Critical Care Medicine, OLV Hospital, Aalst, Belgium
| | - Koen De Decker
- Departments of Anaesthesia and Critical Care Medicine, OLV Hospital, Aalst, Belgium
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Maeremans J, Kayaert P, Bataille Y, Bennett J, Ungureanu C, Haine S, Vandendriessche T, Sonck J, Scott B, Coussement P, Dendooven D, Pereira B, Frambach P, Janssens L, Debruyne P, Van Mieghem C, Barbato E, Cornelis K, Stammen F, De Vroey F, Vercauteren S, Drieghe B, Aminian A, Debrauwere J, Carlier S, Coosemans M, Van Reet B, Vandergoten P, Dens JA. Assessing the landscape of percutaneous coronary chronic total occlusion treatment in Belgium and Luxembourg: the Belgian Working Group on Chronic Total Occlusions (BWGCTO) registry. Acta Cardiol 2018; 73:427-436. [PMID: 29183248 DOI: 10.1080/00015385.2017.1408891] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Important developments in materials, devices, and techniques have improved outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), and resulted in a growing interest in CTO-PCI. The Belgian Working Group on Chronic Total Occlusions (BWGCTO) working group aims to assess the evolution within the CTO-PCI landscape over the next years. Methods: From May 2016 onwards, patients undergoing CTO-PCI were included in the BWGCTO registry by 15 centres in Belgium and Luxemburg. Baseline, angiographic, and procedural data were collected. Here, we report on the one-year in-hospital outcomes. Results: Over the course of one year, 411 procedures in 388 patients were included with a mean age of 64 ± 11 years. The majority were male (81%). Relatively complex CTOs were treated (Japanese CTO score =2.2 ± 1.2) with a high procedure success rate (82%). Patient- and lesion-wise success rates were 83 and 85%, respectively. Major adverse in-hospital events were acceptably low (3.4%). Antegrade wire escalation technique was applied most frequently (82%). On the other hand, antegrade dissection and re-entry and retrograde strategies were more frequently applied in higher volume centres and successful for lesions with higher complexity. Conclusion: Satisfactory procedural outcomes and a low rate of adverse events were obtained in a complex CTO population, treated by operators with variable experience levels. Antegrade wire escalation was the preferred strategy, regardless of operator volume.
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Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
| | - Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle , Liège , Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Universitair Ziekenhuis Leuven , Leuven , Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, Hôpital de Jolimont , Haine-Saint-Paul , Belgium
| | - Steven Haine
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Tom Vandendriessche
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Benjamin Scott
- Department of Cardiology, Hartcentrum ZNA , Antwerpen , Belgium
| | | | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Peter Frambach
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis , Bonheiden , Belgium
| | | | - Carlos Van Mieghem
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | - Emanuele Barbato
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Frederic De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi , Charleroi , Belgium
| | | | - Benny Drieghe
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | | | | | - Mark Coosemans
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | | | - Jo Andre Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
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Maeremans J, Verhaert D, Pereira B, Frambach P, Van Mieghem C, Barbato E, Willems E, Vrolix M, Dens J. One-year clinical and computed tomography follow-up after implantation of bioresorbable vascular scaffolds in patients with coronary chronic total occlusions. Catheter Cardiovasc Interv 2017; 92:488-496. [DOI: 10.1002/ccd.27390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - David Verhaert
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Bruno Pereira
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | - Peter Frambach
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | | | - Emanuele Barbato
- Department of Cardiology; Onze-Lieve-Vrouw-Ziekenhuis; Aalst Belgium
- Department of Advanced Biomedical Medicine; University of Naples Federico II; Naples Italy
| | - Endry Willems
- Department of Radiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Mathias Vrolix
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
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Affiliation(s)
- Anastasios Milkas
- Cardiovascular Centre Aalst, OLV Clinic, Moorselbaan 164, Aalst B-9300, Belgium
- Athens Naval and Veterans Hospital, Deinokratous 70, Athens, Greece
| | - Carlos Van Mieghem
- Cardiovascular Centre Aalst, OLV Clinic, Moorselbaan 164, Aalst B-9300, Belgium
| | - Lieven Van Hoe
- Department of radiology, OLV hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Emanuele Barbato
- Cardiovascular Centre Aalst, OLV Clinic, Moorselbaan 164, Aalst B-9300, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Bernard De Bruyne
- Cardiovascular Centre Aalst, OLV Clinic, Moorselbaan 164, Aalst B-9300, Belgium
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Aminian A, Iglesias JF, Van Mieghem C, Zuffi A, Ferrara A, Manih R, Dolatabadi D, Lalmand J, Saito S. First prospective multicenter experience with the 7 French Glidesheath slender for complex transradial coronary interventions. Catheter Cardiovasc Interv 2016; 89:1014-1020. [DOI: 10.1002/ccd.26773] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/22/2016] [Accepted: 08/07/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Adel Aminian
- Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | | | | | - Andrea Zuffi
- Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | | | - Roukos Manih
- Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | | | - Jacques Lalmand
- Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
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10
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Alzand BSN, Vanneste L, Fonck D, Van Mieghem C. Spontaneous coronary artery dissection undissolved using cardiac computed tomography. Int J Cardiol 2016; 222:1040-1041. [PMID: 27537544 DOI: 10.1016/j.ijcard.2016.08.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Becker S N Alzand
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium; Department of Cardiology, Onze Lieve Vrouw General Hospital, Aalst, Belgium.
| | - Laurent Vanneste
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium
| | - Didier Fonck
- Department of Radiology, Glorieux General Hospital, Ronse, Belgium
| | - Carlos Van Mieghem
- Department of Cardiology, Onze Lieve Vrouw General Hospital, Aalst, Belgium
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11
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De Beenhouwer T, Hofmans M, De Bleecker J, Brandt I, Van Mieghem C. Myopathy mimicking an acute coronary syndrome. Acta Clin Belg 2016; 71:426-427. [PMID: 27104632 DOI: 10.1080/17843286.2015.1115629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Adjedj J, Meert V, Vanderheyden M, Van Mieghem C. Direct coronary drainage to the left ventricle via Thebesian veins: series report with histologic and cardiac CT analysis. EUROINTERVENTION 2016; 11:1564. [PMID: 27107318 DOI: 10.4244/eijv11i13a302] [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)
- Julien Adjedj
- Cardiovascular Centre Aalst, OLV Clinic Aalst, Aalst, Belgium
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13
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Affiliation(s)
- Julien Adjedj
- Cardiovascular Research Centre Aalst, OLV Clinic, Moorselbaan, 164, Aalst B-9300, Belgium
| | - Angela Ferrara
- Cardiovascular Research Centre Aalst, OLV Clinic, Moorselbaan, 164, Aalst B-9300, Belgium
| | - Martin Penicka
- Cardiovascular Research Centre Aalst, OLV Clinic, Moorselbaan, 164, Aalst B-9300, Belgium
| | - Carlos Van Mieghem
- Cardiovascular Research Centre Aalst, OLV Clinic, Moorselbaan, 164, Aalst B-9300, Belgium
| | - William Wijns
- Cardiovascular Research Centre Aalst, OLV Clinic, Moorselbaan, 164, Aalst B-9300, Belgium
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14
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Dewilde WJM, Janssen PW, Kelder JC, Verheugt FW, De Smet BJ, Adriaenssens T, Vrolix M, Brueren GB, Van Mieghem C, Cornelis K, Vos J, Breet NJ, ten Berg JM. Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial. EUROINTERVENTION 2015; 11:381-90. [DOI: 10.4244/eijy14m06_07] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Pellicano M, Toth G, Di Gioia G, Rusinaru D, Wijns W, Barbato E, De Bruyne B, Degrieck I, Van Mieghem C. Unrecognized anomalous left circumflex coronary artery arising from right sinus of Valsalva: a source of perioperative complication. J Cardiovasc Med (Hagerstown) 2015; 17 Suppl 2:e228-e230. [PMID: 25674881 DOI: 10.2459/jcm.0000000000000251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: In this article we provide a very interesting and challenging PCI of unrecognized anomalous left circumflex coronary artery (LCx) arising from right sinus of Valsalva (RSV) after aortic valve replacement (AVR).This case presentation focuses the attention on important criteria for recognition of abnormal LCx coronary artery, that is the most frequent congenital coronary variant. Failure to demonstrate the anomaly can lead to erroneous interpretation of coronary anatomy with fatal complication in case of aortic valve replacement, as a consequence of accidental ligation or compression of the anomalous vessel. This procedure, especially in the presence of a bioprosthesis aortic valve just implanted, constitutes a challenge for the interventional cardiologist and at the same time a question mark regarding the strategy, choice of guiding catheter, guide wire, and type of stent to use.
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16
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Toth GG, Toth B, De Vroey F, Di Serafino L, Pyxaras S, Rusinaru D, Di Gioia G, Pellicano M, Barbato E, Van Mieghem C, Heyndrickx GR, De Bruyne B, Wijns W, Johnson NP. Response to letter regarding article, "revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy". Circ Cardiovasc Interv 2015; 8:e002296. [PMID: 25663323 DOI: 10.1161/circinterventions.115.002296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/16/2022]
Affiliation(s)
- Gabor G Toth
- University Heart Center Graz, Medical University Graz, Graz, Austria
| | - Balint Toth
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Frederic De Vroey
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Luigi Di Serafino
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Stylianos Pyxaras
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Dan Rusinaru
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Giuseppe Di Gioia
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | | | - Guy R Heyndrickx
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - William Wijns
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Nils P Johnson
- Weatherhead PET Center, University of Texas Medical School, Houston, TX
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17
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Toth GG, Toth B, Johnson NP, De Vroey F, Di Serafino L, Pyxaras S, Rusinaru D, Di Gioia G, Pellicano M, Barbato E, Van Mieghem C, Heyndrickx GR, De Bruyne B, Wijns W. Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions. Circ Cardiovasc Interv 2014; 7:751-9. [DOI: 10.1161/circinterventions.114.001608] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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] [Indexed: 01/08/2023]
Abstract
Background—
Fractional flow reserve (FFR) measurement of intermediate coronary stenoses is recommended by guidelines when demonstration of ischemia by noninvasive testing is unavailable. The study aims to evaluate the penetration of this recommendation into current thinking about revascularization strategies for stable coronary artery disease.
Methods and Results—
International Survey on Interventional Strategy was conducted via a web-based platform. First, participants’ experiences in interventional cardiology were queried. Second, 5 complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography values were known; however, remained undisclosed. Determination of stenosis significance was asked for each lesion. In cases of uncertainty, the most appropriate adjunctive invasive diagnostic method among quantitative coronary angiography, intravascular ultrasound, optical coherence tomography, or FFR needed to be selected. International Survey on Interventional Strategy was taken by 495 participants who provided 4421 lesion evaluations. In 3158 (71%) decisions, participants relied solely on angiographic appearance that was discordant in 47% with the known FFR, using 0.80 as cutoff value. The use of FFR and imaging modalities was requested in 21% and 8%, respectively. Comparing 4 groups of participants according to the experience in FFR, angiogram-based decisions were less frequent with increasing experience (77% versus 72% versus 69% versus 67%, respectively;
P
<0.001). As a result, requests for FFR were more frequent (14% versus 19% versus 24% versus 28%, respectively;
P
<0.001) and rates of discordant decisions decreased (51% versus 49% versus 47% versus 43%, respectively;
P
<0.022).
Conclusions—
The findings confirm that, even when all potential external constraints are virtually eliminated, visual estimation continues to dominate the treatment decisions for intermediate stenoses, indicative of a worrisome disconnect between recommendations and current practice.
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Affiliation(s)
- Gabor G. Toth
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Balint Toth
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Nils P. Johnson
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Frederic De Vroey
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Luigi Di Serafino
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Stylianos Pyxaras
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Dan Rusinaru
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Giuseppe Di Gioia
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Mariano Pellicano
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Emanuele Barbato
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Carlos Van Mieghem
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Guy R. Heyndrickx
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Bernard De Bruyne
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - William Wijns
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
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Wijns W, Van Mieghem C, Penicka M. Minimizing CT angiography radiation burden while maintaining accuracy through noise reduction: is lower always better? J Am Coll Cardiol 2014; 64:781-3. [PMID: 25145521 DOI: 10.1016/j.jacc.2014.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- William Wijns
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium.
| | | | - Martin Penicka
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
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19
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Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, Di Serafino L, Muller O, Van Mieghem C, Wyffels E, Heyndrickx GR, Bartunek J, Vanderheyden M, Barbato E, Wijns W, De Bruyne B. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J 2014; 35:2831-8. [DOI: 10.1093/eurheartj/ehu094] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Smits PC, Sheikjoesoef K, Royaards KJ, Vlachojannis G, Kedhi E, Wassing J, McFadden EP, Van Mieghem C, van der Ent M. TCT-13 Final Five Year Results From The All-comer COMPARE Trial: A Prospective, Randomized Trial of Everolimus-Eluting vs. Paclitaxel-Eluting Stents. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Toth G, De Bruyne B, Casselman F, De Vroey F, Pyxaras S, Di Serafino L, Van Praet F, Van Mieghem C, Stockman B, Wijns W, Degrieck I, Barbato E. Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation 2013; 128:1405-11. [PMID: 23985788 DOI: 10.1161/circulationaha.113.002740] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [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: 12/17/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) is well established for patients undergoing percutaneous coronary intervention, yet little is known about candidates for coronary artery bypass graft surgery. METHODS AND RESULTS From 2006 to 2010, we retrospectively included in this registry 627 consecutive patients treated by coronary artery bypass graft surgery having at least 1 angiographically intermediate stenosis. In 429 patients, coronary artery bypass graft surgery was based solely on angiography (angiography-guided group). In 198 patients, at least 1 intermediate stenosis was grafted with an FFR ≤0.80 or deferred with an FFR >0.80 (FFR-guided group). The end point was major adverse cardiovascular events at 3 years, defined as the composite of overall death, myocardial infarction, and target vessel revascularization. The rate of angiographic multivessel disease was similar in the angiography-guided and FFR-guided groups (404 [94.2%] versus 186 [93.9%]; P=0.722). In the FFR-guided group, this was significantly downgraded after FFR measurements to 86.4% (P<0.001 versus before FFR) and was associated with a smaller number of anastomoses (3 [2-3] versus 3 [2-4]; P<0.001) and rate of on-pump surgery (49% versus 69%; P<0.001). At 3 years, major adverse cardiovascular events were not different between the angiography-guided and FFR-guided groups (12% versus 11%; hazard ratio, 1.030; 95% confidence interval, 0.627-1.692; P=0.908). However, the FFR-guided group compared with the angiography-guided group presented a significantly lower rate of angina (Canadian Cardiovascular Society class II-IV, 31% versus 47%; P<0.001). CONCLUSIONS FFR-guided coronary artery bypass graft surgery was associated with a lower number of graft anastomoses and a lower rate of on-pump surgery compared with angiography-guided coronary artery bypass graft surgery. This did not result in a higher event rate during up to 36 months of follow-up and was associated with a lower rate of angina.
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Affiliation(s)
- Gabor Toth
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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22
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Di Serafino L, Pyxaras SA, Mangiacapra F, Dierickx K, Toth G, Bartunek J, De Bruyne B, Van Mieghem C, Wijns W, Barbato E. Influence of transradial versus transfemoral diagnostic heart catheterisation on peripheral vascular endothelial function. EUROINTERVENTION 2013; 8:1252-8. [DOI: 10.4244/eijv8i11a193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Pugliese F, Mollet NR, Hunink MGM, Cademartiri F, Nieman K, van Domburg RT, Meijboom WB, Van Mieghem C, Weustink AC, Dijkshoorn ML, de Feyter PJ, Krestin GP. Diagnostic Performance of Coronary CT Angiography by Using Different Generations of Multisection Scanners: Single-Center Experience. Radiology 2008; 246:384-93. [DOI: 10.1148/radiol.2462070113] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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24
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Mollet NR, Cademartiri F, Van Mieghem C, Meijboom B, Pugliese F, Runza G, Baks T, Dikkeboer J, McFadden EP, Freericks MP, Kerker JP, Zoet SK, Boersma E, Krestin GP, de Feyter PJ. Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris. Eur Heart J 2007; 28:1872-8. [PMID: 17350972 DOI: 10.1093/eurheartj/ehl563] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
AIMS To determine the adjunctive value of CT coronary angiography (CTCA) in the diagnostic work-up of patients with typical angina pectoris. METHODS AND RESULTS CTCA was performed in 62 consecutive patients (45 male, mean age 58.8 +/- 7.7 years) with typical angina undergoing diagnostic work-up including exercise-ECG and conventional coronary angiography. Only patients with sinus heart rhythm and ability to breath hold for 20 s were included. Patients with initial heart rates >/=70 beats/min received beta-blockers. We determined the post-test likelihood ratios, to detect or exclude patients with significant (>/=50% lumen diameter reduction) stenoses, of exercise-ECG and CTCA separately, and of CT performed after exercise-ECG testing. The prevalence of patients with significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios for exercise-ECG were 2.3 [95% confidence interval (CI): 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) and for CTCA 7.5 (95% CI: 2.1-27.1) and 0.0 (95% CI: 0.0-8), respectively. CTCA increased the post-test probability of significant CAD after a negative exercise-ECG from 58 to 91%, and after a positive exercise-ECG from 89 to 99%, while CT correctly identified patients without CAD (probability 0%). CONCLUSION Non-invasive CTCA is a potentially useful tool, in the diagnostic work-up of patients with typical angina pectoris, both to detect and to exclude significant CAD.
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Affiliation(s)
- Nico R Mollet
- Erasmus Medical Center, Department of Cardiology, Room Ca-228a, Dr Molewaterplein 40, Rotterdam 3000CA, The Netherlands.
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Abstract
The ECG is an indispensable tool in the ICU for the detection and diagnosis of heart disease. ECG abnormalities however can be present in a wide variety of noncardiac conditions, complicating the differential diagnosis with primary cardiac pathology. This overview discusses the ECG abnormalities and their pathophysiologic basis in the most frequently encountered noncardiac conditions, such as electrolyte abnormalities, pulmonary embolism, CNS diseases, esophageal disorders, hypothermia, and drug-related and other conditions. Knowledge of the characteristic ECG changes may provide early clues to the presence of these disorders, the prompt recognition of which can be life saving.
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Affiliation(s)
- Carlos Van Mieghem
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
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26
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Van Mieghem C, Dens J, Herregods MC, Desmet W. Left ventricular wall hematoma and cardiac tamponade complicating percutaneous coronary intervention using IIb/IIIa receptor antagonists. J Interv Cardiol 2003; 16:381-4. [PMID: 14603795 DOI: 10.1046/j.1540-8183.2003.01011.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of intramyocardial hematoma and cardiac tamponade after complicated percutaneous coronary intervention is reported. Hemorrhage as a result of the antiplatelet effect of IIb/IIIa receptor antagonists is the considered underlying mechanism.
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Affiliation(s)
- Carlos Van Mieghem
- Department of Cardiology, University Hospital of Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
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