1
|
Kundu A, Moliterno DJ. Drug-Coated Balloons for In-Stent Restenosis-Finally Leaving Nothing Behind for US Patients. JAMA 2024; 331:1011-1012. [PMID: 38460158 DOI: 10.1001/jama.2024.0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Affiliation(s)
- Amartya Kundu
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - David J Moliterno
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| |
Collapse
|
2
|
Misumida N, Moliterno DJ. Coronary Physiology Assessment: On Becoming Faster, Friendlier, and a Better Guiding Companion. JACC Asia 2023; 3:843-845. [PMID: 38155787 PMCID: PMC10751643 DOI: 10.1016/j.jacasi.2023.09.005] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Affiliation(s)
- Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - David J. Moliterno
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
3
|
Angiolillo DJ, Cao D, Sartori S, Baber U, Dangas G, Zhang Z, Vogel B, Kunadian V, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Ielasi A, Stefanini GG, Pivato CA, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Steg PG, Pocock S, Mehran R. Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2514-2524. [PMID: 37879803 DOI: 10.1016/j.jcin.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases. OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI). METHODS In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables. RESULTS The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P = 0.566). CONCLUSIONS In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence.
Collapse
Affiliation(s)
- Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, Roslyn, New York, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kurt Huber
- 3rd Dept Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo A Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | | | - P Gabriel Steg
- Université de Paris and Assistance Paris-Hôpitaux de Paris, Paris, France
| | - Stuart Pocock
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
4
|
Mendieta G, Mehta S, Baber U, Angiolillo DJ, Briguori C, Cohen D, Collier T, Dangas G, Dudek D, Escaned J, Gil R, Vogel B, Cao D, Spirito A, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Sardella G, Sartori S, Sharma S, Shlofmitz R, Steg PG, Han YL, Pocock S, Gibson CM, Mehran R. Bleeding and Ischemic Risks of Ticagrelor Monotherapy After Coronary Interventions. J Am Coll Cardiol 2023; 82:687-700. [PMID: 37587580 DOI: 10.1016/j.jacc.2023.05.062] [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: 03/07/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention), among high-risk patients undergoing percutaneous coronary intervention (PCI), ticagrelor monotherapy vs continuation of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor after completing a 3-month course of DAPT was associated with reduced bleeding, without an increase in ischemic events. OBJECTIVES This investigation sought to study the clinical benefit of ticagrelor monotherapy vs DAPT by simultaneously modeling its associated potential bleeding benefits and ischemic harms on an individual patient basis. METHODS Multivariable Cox regression models for: 1) Bleeding Academic Research Consortium type 2, 3, or 5 (BARC-2/3/5); and 2) cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke (major adverse cardiac and cerebrovascular event [MACCE]) were developed using stepwise forward variable selection. The coefficients in the BARC-2/3/5 and MACCE models were used to calculate bleeding and ischemic risk scores, respectively, for each patient (excluding the coefficient for randomized treatment). RESULTS In the total study group (N = 7,119), BARC-2/3/5 occurred in 391 (5.5%) patients, and MACCE occurred in 258 (3.6%). There was a consistent reduction in bleeding events associated with ticagrelor monotherapy compared with DAPT across both bleeding and ischemic risk strata (P interaction = 0.54 and 0.11, respectively). Importantly, this benefit associated with ticagrelor monotherapy was not offset by an increase in MACCE at any level of bleeding or ischemic risk. CONCLUSIONS Three months after PCI, discontinuing aspirin and maintaining ticagrelor monotherapy reduces bleeding in both higher-bleeding risk and lower-bleeding risk patients compared with continued DAPT. This benefit does not appear to be offset by greater ischemic risk. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242).
Collapse
Affiliation(s)
- Guiomar Mendieta
- National Center of Cardiovascular Investigations Carlos III (CNIC), Madrid, Spain
| | - Shamir Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | | | - David Cohen
- Department of Cardiology, St Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Health Research Institute, San Carlos Clinical Hospital (IDISCC), Complutense University of Madrid, Madrid, Spain
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt Huber
- Third Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Adnan Kastrati
- German Heart Center Munich, Technical University of Munich, German Center for Cardiovascular Research (DZHK) partner site Munich Heart Alliance, Munich, Germany
| | - Upendra Kaul
- Batra Hospital and Medical Research Center, New Delhi, India
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Moliterno
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Gennaro Sardella
- Department of Cardiology, Umberto I Polyclinical University, Rome, Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital, Roslyn, New York, USA
| | - P Gabriel Steg
- Paris Cité University, Public Hospitals of Paris (AP-HP), Bichat Hospital, Paris, France
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Michael Gibson
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
5
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Case Rep 2023; 13:101806. [PMID: 37153478 PMCID: PMC10157143 DOI: 10.1016/j.jaccas.2023.101806] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Basic Transl Sci 2023; 8:596-598. [PMID: 37325406 PMCID: PMC10264704 DOI: 10.1016/j.jacbts.2023.03.005] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Asia 2023; 3:317-319. [PMID: 37181383 PMCID: PMC10167500 DOI: 10.1016/j.jacasi.2023.03.002] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Cardiovasc Imaging 2023; 16:572-574. [PMID: 36939663 DOI: 10.1016/j.jcmg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
|
9
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Cardiovasc Interv 2023; 16:881-883. [PMID: 36935255 DOI: 10.1016/j.jcin.2023.03.001] [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] [Indexed: 03/21/2023]
|
10
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Heart Fail 2023; 11:487-489. [PMID: 36939659 DOI: 10.1016/j.jchf.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
|
11
|
Fuster V, Bozkurt B, Chandrashekhar YS, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. J Am Coll Cardiol 2023; 81:1543-1545. [PMID: 36935264 DOI: 10.1016/j.jacc.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
|
12
|
Kundu A, Dewaswala N, Bhopalwala H, Moliterno DJ. Immediate vs Delayed Coronary Angiography for Out-of-Hospital Cardiac Arrest: A Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv 2023; 16:875-877. [PMID: 36898941 DOI: 10.1016/j.jcin.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 03/12/2023]
|
13
|
Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals’ Pathway Forward With AI Tools. JACC: CardioOncology 2023; 5:275-277. [PMID: 37144104 PMCID: PMC10152189 DOI: 10.1016/j.jaccao.2023.03.001] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Iyengar A, Moliterno DJ. The evolution of medical resident training and healthcare delivery: Good riddance to the "July effect". Catheter Cardiovasc Interv 2023; 101:274-275. [PMID: 36748781 DOI: 10.1002/ccd.30584] [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: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
Key Points
The present observational study from the National Inpatient Sample found no evidence of a “July effect” associated with acute myocardial infarction (AMI) in‐hospital mortality rates in teaching hospitals.
Multifactorial quality improvement in the delivery of care for AMI patients has ameliorated potentially detrimental effects of trainee inexperience historically observed in high‐risk admissions.
Efforts to minimize unnecessary variability in care delivery and to consistently implement guideline‐directed medical therapy are ongoing via electronic health record software.
Collapse
Affiliation(s)
- Amrita Iyengar
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
15
|
Sardella G, Beerkens FJ, Dangas G, Cao D, Baber U, Sartori S, Cohen DJ, Briguori C, Gil R, Nicolas J, Zhang Z, Dudek D, Kunadian V, Kornowski R, Weisz G, Claessen B, Marx S, Escaned J, Huber K, Collier T, Moliterno DJ, Ohman EM, Krucoff MW, Kastrati A, Steg PG, Angiolillo DJ, Mehta S, Shlofmitz R, Sharma S, Pocock S, Gibson CM, Mehran R. Ticagrelor with and without aspirin in patients with a prior coronary artery bypass graft undergoing percutaneous coronary intervention: the TWILIGHT-CABG study. EUROINTERVENTION 2022; 18:e897-e909. [PMID: 35979636 PMCID: PMC9743241 DOI: 10.4244/eij-d-22-00319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 04/05/2022] [Accepted: 07/12/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Prior coronary artery bypass graft surgery (CABG) patients undergoing percutaneous coronary intervention (PCI) are often older and present with multiple comorbidities. Ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) has emerged as an effective bleeding-avoidance strategy among high-risk patients. AIMS We aimed to examine the effects of ticagrelor with or without aspirin in prior CABG patients undergoing PCI within the TWILIGHT trial. METHODS After 3 months of ticagrelor plus aspirin, patients were randomised to either aspirin or placebo, in addition to ticagrelor, for 12 months and compared by prior CABG status. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was all-cause death, myocardial infarction (MI), or stroke. RESULTS Out of 7,119 patients, a total of 703 (10.8%) patients had prior CABG within the randomised cohort. Prior CABG patients had more comorbidities and a higher incidence of BARC type 2, 3, or 5 bleeding and death, MI or stroke at 1 year after randomisation, compared with patients without prior CABG. Ticagrelor monotherapy was associated with significantly less BARC 2, 3, or 5 bleeding among prior CABG patients compared with DAPT (4.9% vs 9.6%, hazard ratio [HR] 0.50, 95% confidence interval [CI]: 0.28 to 0.90; pinteraction=0.676) and similar rates of death, MI or stroke (10.0% vs 8.7%, HR 1.14, 95% CI: 0.70 to 1.87; pinteraction=0.484). When comparing target vessel type, treatment effects were consistent among graft- and native-vessel interventions. CONCLUSIONS In high-risk patients with prior CABG, ticagrelor monotherapy reduced bleeding without compromising ischaemic outcomes compared with ticagrelor plus aspirin.
Collapse
Affiliation(s)
- Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I University, Rome, Italy
| | - Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samantha Sartori
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J Cohen
- Department of Cardiology, St. Francis Hospital & Heart Center, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Johny Nicolas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dariusz Dudek
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Giora Weisz
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bimmer Claessen
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Steven Marx
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany and German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL , USA
| | - Shamir Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Samin Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
16
|
Moliterno DJ. Toward a More Interactive Central Illustration. JACC Cardiovasc Interv 2022; 15:2237-2238. [DOI: 10.1016/j.jcin.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
17
|
Spirito A, Kastrati A, Moliterno DJ, Baber U, Cao D, Sartori S, Collier T, Gibson CM, Angiolillo DJ, Pocock SJ, Cohen DJ, Escaned J, Sardella G, Dangas G, Mehran R. Impact of different antiplatelet therapy cessation modes on outcomes in patients treated with ticagrelor with or without aspirin after PCI: the twilight-antiplatelet cessation study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1232] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT) trial showed that a regimen consisting of a 3-month dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy reduces the rate of bleeding events without increasing ischemic complications compared with standard DAPT [1]. Previous studies, such as Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients (PARIS) demonstrated how deviation or cessation of the prescribed antiplatelet regimen might negatively affect clinical outcomes [2].
Purpose
The proposed analysis aims to assess the impact of different antiplatelet therapy cessation patterns on ischemic and bleeding outcomes in patients treated with ticagrelor with or without aspirin after percutaneous coronary intervention (PCI).
Methods
All 7,119 patients randomized at 3 months post-PCI in the TWILIGHT study will be included. The analyses will be conducted separately in the two treatment arms (ticagrelor plus placebo and ticagrelor plus aspirin). According to the PARIS study definitions and as prespecified in the TWILIGHT trial protocol, the occurrence of the three following antiplatelet cessation modes will be assessed: 1) discontinuation (e.g., caused by intolerable side effects or because of a safety concern); 2) interruption (temporary, <14 days, because of surgical or other invasive procedures); 3) disruption (due to non-compliance or bleeding).
The primary endpoint will be the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months after randomization. The key secondary endpoint will be BARC type 2, 3 or 5 bleeding. Other secondary endpoints will include the components of the primary endpoint, cardiovascular death, definite or probable stent thrombosis and BARC types 3 or 5 bleeding. The number of events will be estimated according to the antiplatelet cessation status before the clinical event. Hazard ratios and 95% confidence intervals will be generated using Cox proportional hazards models including antiplatelet therapy cessation as a time-updated variable. If more than one cessation event occurred during follow-up, the antiplatelet therapy cessation category will change only if the more recent mode is worse than the previous: disruption will have priority over interruption, which in turn will have priority over discontinuation. Patients without cessation events will represent the reference group. All adverse events and episodes of antiplatelet cessation were independently adjudicated.
Results
The results of this analysis will be presented for the first time at ESC 2022.
Conclusion
This prespecified analysis of the TWILIGHT study will show for the first time the impact on clinical outcomes of different antiplatelet therapy cessation modes when a regimen of Ticagrelor with our without aspirin is prescribed after PCI.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Astra Zeneca, United Kingdom
Collapse
Affiliation(s)
- A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Kastrati
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - D J Moliterno
- University of Kentucky, Division of Cardiovascular Medicine, Gill Heart Institute , Lexington , United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - T Collier
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics , London , United Kingdom
| | - C M Gibson
- Beth Israel Deaconess Medical Center , Boston , United States of America
| | - D J Angiolillo
- University of Florida College of Medicine , Jacksonville , United States of America
| | - S J Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics , London , United Kingdom
| | - D J Cohen
- St. Francis Hospital, Department of Cardiology , Roslyn , United States of America
| | - J Escaned
- Complutense University of Madrid, Hospital Clínico San Carlos IDISCC , Madrid , Spain
| | - G Sardella
- Polyclinic Umberto I, Department of Cardiovascular Sciences , Rome , Italy
| | - G Dangas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| |
Collapse
|
18
|
Kunadian V, Baber U, Pivato CA, Cao D, Dangas G, Sartori S, Zhang Z, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Dehghani P, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Džavík V, Gurbel P, Hamm CW, Henry T, Kastrati A, Marx SO, Oldroyd K, Steg PG, Pocock S, Mehran R. Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index. JACC Cardiovasc Interv 2022; 15:1948-1960. [DOI: 10.1016/j.jcin.2022.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
|
19
|
Dehghani P, Cao D, Baber U, Nicolas J, Sartori S, Pivato CA, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy after PCI in patients with concomitant diabetes mellitus and chronic kidney disease: TWILIGHT DM-CKD. Eur Heart J Cardiovasc Pharmacother 2022; 8:707-716. [PMID: 35325085 DOI: 10.1093/ehjcvp/pvac016] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Indexed: 11/14/2022]
Abstract
AIMS We aimed to evaluate the treatment effects of ticagrelor monotherapy in the very high-risk cohort of patients with concomitant diabetes mellitus (DM) and chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In the TWILIGHT trial, after 3-month dual antiplatelet therapy with ticagrelor and aspirin post-PCI, event-free patients were randomized to either aspirin or placebo in addition to ticagrelor for 12 months. Those with available information on DM and CKD status were included in this subanalysis and were stratified by the presence or absence of either condition: 3391 (54.1%) had neither DM nor CKD (DM-/CKD-), 1822 (29.0%) had DM only (DM+/CKD-), 561 (8.9%) had CKD only (DM-/CKD+), and 8.0% had both DM and CKD (DM+/CKD+). The incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding did not differ according to DM/CKD status (p-trend = 0.13), but there was a significant increase in BARC 3 or 5 bleeding (p-trend<0.001) as well as the key secondary endpoint of death, myocardial infarction, or stroke (p-trend<0.001). Ticagrelor plus placebo reduced bleeding events compared with ticagrelor plus aspirin across all four groups, including DM+/CKD+ patients with respect to BARC 2-5 (4.5% vs. 8.7%; HR 0.49, 95% CI 0.24-1.01) as well as BARC 3-5 (0.8% vs. 5.3%; HR 0.15, 95% CI 0.03-0.53) bleeding, with no evidence of heterogeneity. The risk of death, myocardial infarction, or stroke was similar between treatment arms across all groups. CONCLUSIONS Irrespective of the presence of DM, CKD, and their combination, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischemic events compared with ticagrelor plus aspirin.
Collapse
Affiliation(s)
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo A Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, NY, USA.,St. Francis Hospital, Roslyn, Roslyn, NY, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kurt Huber
- 3rd Dept Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, NY, USA
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
20
|
Dangas G, Baber U, Sharma S, Giustino G, Sartori S, Nicolas J, Goel R, Mehta S, Cohen D, Angiolillo DJ, Zhang Z, Camaj A, Cao D, Briguori C, Dudek D, Escaned J, Huber K, Collier T, Kornowski R, Kunadian V, Moliterno DJ, Ohman EM, Weisz G, Gil R, Krucoff MW, Kaul U, Oldroyd KG, Sardella G, Shlofmitz R, Witzenbichler B, Kastrati A, Han YL, Steg PG, Pocock S, Gibson CM, Mehran R. Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type: the TWILIGHT-STENT study. EUROINTERVENTION 2022; 17:1330-1339. [PMID: 34881696 PMCID: PMC9743248 DOI: 10.4244/eij-d-21-00721] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). AIMS The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type. METHODS In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation. RESULTS Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; pinteraction=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; pinteraction=0.60). In both unadjusted and covariate-adjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications. CONCLUSIONS As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
Collapse
Affiliation(s)
- George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shamir Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David Cohen
- St. Francis Hospital, Roslyn NY and Cardiovascular Research Foundation, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center, NY, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Upendra Kaul
- Batra Hospital and Medical Research Center, New Delhi, India
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | | | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Munchen, Munchen, Germany
| | - Ya-Ling Han
- Department of Cardiology, Shenyang North Hospital, Shenyang Shi, China
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
21
|
Moliterno DJ. JACC: Cardiovascular Interventions Top Reviewers 2021. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
22
|
Dexter N, Moliterno DJ. Evolving our learning and application of knowledge to practice-The ongoing challenges of time and cost in interventional cardiology. Catheter Cardiovasc Interv 2022; 99:17-18. [PMID: 34994510 DOI: 10.1002/ccd.30036] [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] [Received: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Nicole Dexter
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - David J Moliterno
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
23
|
Escaned J, Cao D, Baber U, Nicolas J, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta S, Moliterno DJ, Ohman EM, Oldroyd KG, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR. Eur Heart J 2021; 42:4624-4634. [PMID: 34662382 DOI: 10.1093/eurheartj/ehab702] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 07/20/2021] [Revised: 08/08/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Patients at high bleeding risk (HBR) represent a prevalent subgroup among those undergoing percutaneous coronary intervention (PCI). Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy. The aim of this study was to assess the effects of ticagrelor monotherapy after 3-month DAPT in a contemporary HBR population. METHODS AND RESULTS This prespecified analysis of the TWILIGHT trial evaluated the treatment effects of early aspirin withdrawal followed by ticagrelor monotherapy in HBR patients undergoing PCI with drug-eluting stents. After 3 months of ticagrelor plus aspirin, event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor. A total of 1064 (17.2%) met the Academic Research Consortium definition for HBR. Ticagrelor monotherapy reduced the incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding compared with ticagrelor plus aspirin in HBR (6.3% vs. 11.4%; hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.35-0.82) and non-HBR patients (3.5% vs. 5.9%; HR 0.59, 95% CI 0.46-0.77) with similar relative (Pinteraction = 0.67) but a trend towards greater absolute risk reduction in the former [-5.1% vs. -2.3%; difference in absolute risk differences (ARDs) -2.8%, 95% CI -6.4% to 0.8%, P = 0.130]. A similar pattern was observed for more severe BARC 3 or 5 bleeding with a larger absolute risk reduction in HBR patients (-3.5% vs. -0.5%; difference in ARDs -3.0%, 95% CI -5.2% to -0.8%, P = 0.008). There was no significant difference in the key secondary endpoint of death, myocardial infarction, or stroke between treatment arms, irrespective of HBR status. CONCLUSIONS Among HBR patients undergoing PCI who completed 3-month DAPT without experiencing major adverse events, aspirin discontinuation followed by ticagrelor monotherapy significantly reduced bleeding without increasing ischaemic events, compared with ticagrelor plus aspirin. The absolute risk reduction in major bleeding was larger in HBR than non-HBR patients.
Collapse
Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid 28040, Spain
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw 02-507, Poland
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Sigmund Freud University, Medical Faculty, Vienna 1160, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Richard Shlofmitz
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| |
Collapse
|
24
|
Hawamdeh H, Moliterno DJ. Finding sideline benefits-Of pandemics and same-day-discharge following rotational atherectomy. Catheter Cardiovasc Interv 2021; 98:689-690. [PMID: 34596334 PMCID: PMC8652616 DOI: 10.1002/ccd.29909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
The occurrence of same‐day discharge following elective rotational atherectomy cases in England and Wales during 2007–2014 increased from approximately 7 to 36%. High‐volume centers and transradial approach were associated with more likelihood of same‐day discharge. As compared with patients who stayed for overnight observation following elective rotational atherectomy, those discharged the same day as the procedure had a similar rate of 30‐day mortality (0.35 and 0.50%, respectively; p = 0.409).
Collapse
Affiliation(s)
- Hussam Hawamdeh
- From the Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - David J Moliterno
- From the Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
25
|
White CJ, Samady H, Moliterno DJ. The Case for Mandatory COVID-19 Vaccination of Health Care Workers. JACC Cardiovasc Interv 2021; 14:1961-1962. [PMID: 34503752 PMCID: PMC8420890 DOI: 10.1016/j.jcin.2021.07.055] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Stefanini GG, Briguori C, Cao D, Baber U, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Mehta S, Cohen DJ, Collier T, Dudek D, Escaned J, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Oldroyd KG, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy in patients with chronic kidney disease undergoing percutaneous coronary intervention: TWILIGHT-CKD. Eur Heart J 2021; 42:4683-4693. [PMID: 34423374 DOI: 10.1093/eurheartj/ehab533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/13/2021] [Revised: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to assess the impact of chronic kidney disease (CKD) on the safety and efficacy of ticagrelor monotherapy among patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In this prespecified subanalysis of the TWILIGHT trial, we evaluated the treatment effects of ticagrelor with or without aspirin according to renal function. The trial enrolled patients undergoing drug-eluting stent implantation who fulfilled at least one clinical and one angiographic high-risk criterion. Chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, was a clinical study entry criterion. Following a 3-month period of ticagrelor plus aspirin, event-free patients were randomly assigned to aspirin or placebo on top of ticagrelor for an additional 12 months. Of the 6835 patients randomized and with available eGFR at baseline, 1111 (16.3%) had CKD. Ticagrelor plus placebo reduced the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding as compared with ticagrelor plus aspirin in both patients with [4.6% vs. 9.0%; hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31-0.80] and without (4.0% vs. 6.7%; HR 0.59, 95% CI 0.47-0.75; Pinteraction = 0.508) CKD, but the absolute risk reduction was greater in the former group. Rates of death, myocardial infarction, or stroke were not significantly different between the two randomized groups irrespective of the presence (7.9% vs. 5.7%; HR 1.40, 95% CI 0.88-2.22) or absence of (3.2% vs. 3.6%; HR 0.90, 95% CI 0.68-1.20; Pinteraction = 0.111) CKD. CONCLUSION Among CKD patients undergoing PCI, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischaemic events as compared with ticagrelor plus aspirin.
Collapse
Affiliation(s)
- Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20090, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | | | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Usman Baber
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Timothy Collier
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid 28040, Spain
| | | | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw 02-507, Poland
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith G Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| |
Collapse
|
27
|
Angiolillo DJ, Cao D, Baber U, Sartori S, Zhang Z, Dangas G, Mehta S, Briguori C, Cohen DJ, Collier T, Dudek D, Escaned J, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Oldroyd K, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Impact of Age on the Safety and Efficacy of Ticagrelor Monotherapy in Patients Undergoing PCI. JACC Cardiovasc Interv 2021; 14:1434-1446. [PMID: 34238553 DOI: 10.1016/j.jcin.2021.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/23/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact of age on the safety and efficacy of ticagrelor monotherapy after percutaneous coronary intervention (PCI). BACKGROUND As the risk for bleeding and ischemic complications after PCI increases with age, the authors conducted a pre-specified analysis of the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial to evaluate the possible benefits of ticagrelor monotherapy according to age. METHODS The TWILIGHT trial enrolled patients undergoing PCI with drug-eluting stents who fulfilled at least 1 clinical and 1 angiographic high-risk criterion. Age ≥65 years was a clinical entry criterion. After 3 months of dual-antiplatelet therapy with ticagrelor, event-free patients were randomized to ticagrelor plus placebo or ticagrelor plus aspirin for an additional 12 months. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. RESULTS A total of 3,113 patients (47.7%) were ≥65 years of age. At 1 year after randomization, ticagrelor monotherapy significantly reduced BARC type 2, 3, or 5 bleeding (4.5% vs. 8.2%; hazard ratio: 0.53; 95% confidence interval: 0.40 to 0.71) without increasing ischemic events (4.2% vs. 4.4%; hazard ratio: 0.96; 95% confidence interval: 0.68 to 1.35) compared with ticagrelor plus aspirin among patients ≥65 years of age. These findings were consistent in patients <65 years of age with respect to the primary (pinteraction = 0.62) and key secondary (pinteraction = 0.77) endpoints and across different age categories. CONCLUSIONS A strategy of ticagrelor monotherapy following 3 months of dual-antiplatelet therapy significantly reduced clinically relevant bleeding compared with ticagrelor plus aspirin without an increase in ischemic events, irrespective of age.
Collapse
Affiliation(s)
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Usman Baber
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Timothy Collier
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Keith Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | | | - Giora Weisz
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA.
| |
Collapse
|
28
|
Andress K, Moliterno DJ. Acute ischemic stroke and the acute need for expansion of stroke teams and their membership. Catheter Cardiovasc Interv 2021. [DOI: 10.1002/ccd.29533] [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: 11/11/2022]
Affiliation(s)
- Krystof Andress
- Gill Heart Institute and Division of Cardiovascular Medicine University of Kentucky Lexington Kentucky
| | - David J. Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine University of Kentucky Lexington Kentucky
| |
Collapse
|
29
|
Angiolillo DJ, Bhatt DL, Cannon CP, Eikelboom JW, Gibson CM, Goodman SG, Granger CB, Holmes DR, Lopes RD, Mehran R, Moliterno DJ, Price MJ, Saw J, Tanguay JF, Faxon DP. Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective: 2021 Update. Circulation 2021; 143:583-596. [PMID: 33555916 DOI: 10.1161/circulationaha.120.050438] [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] [Indexed: 01/03/2023]
Abstract
A growing number of patients undergoing percutaneous coronary intervention (PCI) with stent implantation also have atrial fibrillation. This poses challenges for their optimal antithrombotic management because patients with atrial fibrillation undergoing PCI require oral anticoagulation for the prevention of cardiac thromboembolism and dual antiplatelet therapy for the prevention of coronary thrombotic complications. The combination of oral anticoagulation and dual antiplatelet therapy substantially increases the risk of bleeding. Over the last decade, a series of North American Consensus Statements on the Management of Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention have been reported. Since the last update in 2018, several pivotal clinical trials in the field have been published. This document provides a focused updated of the 2018 recommendations. The group recommends that in patients with atrial fibrillation undergoing PCI, a non-vitamin K antagonist oral anticoagulant is the oral anticoagulation of choice. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor should be given to all patients during the peri-PCI period (during inpatient stay, until time of discharge, up to 1 week after PCI, at the discretion of the treating physician), after which the default strategy is to stop aspirin and continue treatment with a P2Y12 inhibitor, preferably clopidogrel, in combination with a non-vitamin K antagonist oral anticoagulant (ie, double therapy). In patients at increased thrombotic risk who have an acceptable risk of bleeding, it is reasonable to continue aspirin (ie, triple therapy) for up to 1 month. Double therapy should be given for 6 to 12 months with the actual duration depending on the ischemic and bleeding risk profile of the patient, after which patients should discontinue antiplatelet therapy and receive oral anticoagulation alone.
Collapse
Affiliation(s)
- Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., D.P.F.)
| | - Christopher P Cannon
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., D.P.F.)
| | - John W Eikelboom
- Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, Canada (J.W.E.)
| | - C Michael Gibson
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Shaun G Goodman
- St Michael's Hospital, University of Toronto, Canada (S.G.G.).,The Canadian Heart Research Centre, Toronto, Canada (S.G.G.).,Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.G.G.)
| | | | - David R Holmes
- Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.)
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G., R.D.L.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.)
| | - David J Moliterno
- Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.)
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.)
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (J.S.)
| | - Jean-Francois Tanguay
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada (J.-F.T.)
| | - David P Faxon
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., D.P.F.)
| |
Collapse
|
30
|
Whiteside HL, Moliterno DJ. Coronary interventions among patients with hepatic insufficiency: Encouragement to avoid a jaundiced view. Catheter Cardiovasc Interv 2020; 96:811-812. [PMID: 33085200 DOI: 10.1002/ccd.29277] [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] [Received: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Hoyle L Whiteside
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
31
|
Affiliation(s)
- David J Moliterno
- Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
- Lexington VA Medical Center, Lexington, Kentucky
| | - Susan S Smyth
- Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
- Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed Abdel-Latif
- Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
- Lexington VA Medical Center, Lexington, Kentucky
| |
Collapse
|
32
|
Marquis-Gravel G, Moliterno DJ, Francis DP, Jüni P, Rosenberg YD, Claessen BE, Mentz RJ, Mehran R, Cutlip DE, Chauhan C, Quella S, Zannad F, Goodman SG. Improving the Design of Future PCI Trials for Stable Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:435-450. [PMID: 32703515 PMCID: PMC10018282 DOI: 10.1016/j.jacc.2020.05.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 01/09/2023]
Abstract
The role of percutaneous coronary interventions in addition to medical therapy for patients with stable coronary artery disease continues to be debated in routine clinical practice, despite more than 2 decades of randomized controlled trials. The residual uncertainty arises from particular challenges facing revascularization trials. Which endpoint do doctors care about, and which do patients care about? Which participants should be enrolled? What background medical therapy should we use? When is placebo control relevant? In this paper, we discuss how these questions can be approached and examine the merits and disadvantages of possible options. Engaging multiple stakeholders, including patients, researchers, regulators, and funders, to ensure the design elements are methodologically valid and clinically meaningful should be an aspirational goal in the development of future trials.
Collapse
Affiliation(s)
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Darrel P Francis
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Peter Jüni
- Department of Medicine and Institute of Health Policy, Management and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yves D Rosenberg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Faiez Zannad
- Clinical Investigation Center 1433, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto and Canadian Heart Research Centre, Toronto, Ontario, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
33
|
|
34
|
Sorrentino S, Sartori S, Baber U, Claessen BE, Giustino G, Chandrasekhar J, Chandiramani R, Cohen DJ, Henry TD, Guedeney P, Ariti C, Dangas G, Gibson CM, Krucoff MW, Moliterno DJ, Colombo A, Vogel B, Chieffo A, Kini AS, Witzenbichler B, Weisz G, Steg PG, Pocock S, Urban P, Mehran R. Bleeding Risk, Dual Antiplatelet Therapy Cessation, and Adverse Events After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e008226. [DOI: 10.1161/circinterventions.119.008226] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/17/2023]
Abstract
Background:
Whether the underlying risk of bleeding influences the associations between patterns of dual antiplatelet therapy (DAPT) cessation and adverse events after percutaneous coronary intervention is unknown.
Methods:
Patients enrolled in the prospective, international, multicenter PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were categorized according to their risk of bleeding using the PARIS bleeding risk score. We evaluated the incidence, patterns, and association between modes of DAPT cessation and outcomes across bleeding risk groups. Modes of DAPT cessations were defined as physician-guided DAPT discontinuation, brief interruption (<14 days) or disruption for bleeding, or noncompliance. The primary end point of interest was major adverse cardiac events, defined as the composite of cardiac death, myocardial infarction, or definite-probable stent thrombosis.
Results:
From a total of 5018 patients, 513 (10.2%) were classified as high, 2058 (41.0%) as intermediate, and 2447 (48.8%) as low risk for bleeding. High bleeding risk (HBR) patients were older and had greater prevalence of comorbidities. Compared with non-HBR, HBR patients had higher rates of both ischemic and bleeding events. The cumulative incidence of DAPT cessation was higher in HBR patients, mostly driven by physician-guided discontinuation and disruption. Of note, DAPT disruption occurred in 17.7%, 10.4%, and 7.8% at 1 year and 22.0%, 15.1%, and 12.0% at 2 years (
P
<0.0001) in high, intermediate, and low bleeding risk groups, respectively. Physician-guided DAPT discontinuation was not associated with increased risk of major adverse cardiac events in both HBR and non-HBR patients, while DAPT disruption was associated with an increased risk of major adverse cardiac events across all bleeding risk groups. There was no interaction between bleeding risk status and clinical outcomes for any cessation mode.
Conclusions:
Patients at HBR remain at higher risk of adverse events. Disruption of DAPT is associated with an increased risk of major adverse cardiac events irrespective of the underlying bleeding risk. Physician-guided discontinuation of DAPT appears to be safe, irrespective of HBR.
Collapse
Affiliation(s)
- Sabato Sorrentino
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (S. Sorrentino)
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Usman Baber
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Bimmer E. Claessen
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Gennaro Giustino
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | | | - David J. Cohen
- Department of Internal Medicine, Section: Cardiovascular Disease, St. Luke’s Mid America Heart Institute, University of Missouri-Kansas City, The Christ Hospital Heart and Vascular Center, (D.J.C.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH (T.D.H.)
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN (T.D.H.)
| | - Paul Guedeney
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Cono Ariti
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)
| | - George Dangas
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
- Department of Cardiology, National and Kapodistrian University of Athens, Greece (G.D.)
| | - C. Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Mitchell W. Krucoff
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC (M.W.K.)
| | - David J. Moliterno
- Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington (D.J.M.)
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.C.)
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | - Alaide Chieffo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A.C.)
| | - Annapoorna S. Kini
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| | | | - Giora Weisz
- Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.)
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)
| | - Philip Urban
- Cardiology Department, Hopital LaTour, Geneva, Switzerland (P.U.)
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)
| |
Collapse
|
35
|
Ungar L, Clare RM, Rodriguez F, Kolls BJ, Armstrong PW, Aylward P, Held C, Moliterno DJ, Strony J, Van de Werf F, Wallentin L, White HD, Tricoci P, Harrington RA, Mahaffey KW, Melloni C. Stroke Outcomes With Vorapaxar Versus Placebo in Patients With Acute Coronary Syndromes: Insights From the TRACER Trial. J Am Heart Assoc 2019; 7:e009609. [PMID: 30526198 PMCID: PMC6405615 DOI: 10.1161/jaha.118.009609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/01/2022]
Abstract
Background Vorapaxar, a protease‐activated receptor‐1 antagonist, is approved for secondary prevention of cardiovascular events but is associated with increased intracranial hemorrhage. Methods and Results TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) was a trial of vorapaxar versus placebo among patients with acute coronary syndrome. Strokes were adjudicated by a central events committee. Of 12 944 patients, 199 (1.5%) had ≥1 stroke during the study period (median follow‐up, 477 days). Four patients had a single stroke of unknown type; 195 patients had ≥1 stroke classified as hemorrhagic or nonhemorrhagic (165 nonhemorrhagic, 28 hemorrhagic, and 2 both). Strokes occurred in 96 of 6473 patients (1.5%) assigned vorapaxar and 103 of 6471 patients (1.6%) assigned placebo. Kaplan‐Meier incidence of stroke for vorapaxar versus placebo was higher for hemorrhagic stroke (0.45% versus 0.14% [hazard ratio, 2.74; 95% confidence interval, 1.22–6.15]), lower but not significantly different for nonhemorrhagic stroke (1.53% versus 1.98% at 2 years [hazard ratio, 0.79; 95% confidence interval, 0.58–1.07]), and similar for stroke overall (1.93% versus 2.13% at 2 years [hazard ratio, 0.94; 95% confidence interval, 0.71–1.24]). Conclusions Stroke occurred in <2% of patients. Vorapaxar‐assigned patients had increased hemorrhagic stroke but a nonsignificant trend toward lower nonhemorrhagic stroke. Overall stroke frequency was similar with vorapaxar versus placebo.
Collapse
Affiliation(s)
- Leo Ungar
- 1 Department of Cardiology University of California Irvine Medical Center Orange CA
| | - Robert M Clare
- 2 Department of Medicine Duke Clinical Research Institute Durham NC
| | - Fatima Rodriguez
- 3 Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Bradley J Kolls
- 2 Department of Medicine Duke Clinical Research Institute Durham NC
| | | | - Philip Aylward
- 5 South Australian Health and Medical Research Institute Flinders University and Medical Centre Adelaide Australia
| | - Claes Held
- 6 Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - David J Moliterno
- 7 Division of Cardiovascular Medicine Gill Heart Institute University of Kentucky Lexington KY
| | | | - Frans Van de Werf
- 9 Department of Cardiovascular Sciences University Hospitals Leuven Leuven Belgium
| | - Lars Wallentin
- 6 Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Harvey D White
- 10 Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | | | - Robert A Harrington
- 11 Department of Medicine Stanford University School of Medicine Stanford CA
| | - Kenneth W Mahaffey
- 11 Department of Medicine Stanford University School of Medicine Stanford CA
| | - Chiara Melloni
- 2 Department of Medicine Duke Clinical Research Institute Durham NC
| |
Collapse
|
36
|
Tricoci P, Newby LK, Clare RM, Leonardi S, Gibson CM, Giugliano RP, Armstrong PW, Van de Werf F, Montalescot G, Moliterno DJ, Held C, Aylward PE, Wallentin L, Harrington RA, Braunwald E, Mahaffey KW, White HD. Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 11:856-864. [PMID: 29747915 DOI: 10.1016/j.jcin.2018.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 10/19/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In 13,038 patients with non-ST-segment elevation acute coronary syndrome undergoing index percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome) and TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trials, the relationship between PCI-related myocardial infarction (MI) and 1-year mortality was assessed. BACKGROUND The definition of PCI-related MI is controversial. The third universal definition of PCI-related MI requires cardiac troponin >5 times the 99th percentile of the normal reference limit from a stable or falling baseline and PCI-related clinical or angiographic complications. The definition from the Society for Cardiovascular Angiography and Interventions (SCAI) requires creatine kinase-MB elevation >10 times the upper limit of normal (or 5 times if new electrocardiographic Q waves are present). Implications of these definitions on prognosis, prevalence, and implementation are not established. METHODS In our cohort of patients undergoing PCI, PCI-related MIs were classified using the third universal type 4a MI definition and SCAI criteria. In the subgroup of patients included in the angiographic core laboratory (ACL) substudy of EARLY ACS (n = 1,401) local investigator- versus ACL-reported angiographic complications were compared. RESULTS Altogether, 2.0% of patients met third universal definition of PCI-related MI criteria, and 1.2% met SCAI criteria. One-year mortality was 3.3% with the third universal definition (hazard ratio: 1.96; 95% confidence interval: 1.24 to 3.10) and 5.3% with SCAI criteria (hazard ratio: 2.79; 95% confidence interval: 1.69 to 4.58; p < 0.001). Agreement between ACL and local investigators in detecting angiographic complications during PCI was overall moderate (κ = 0.53). CONCLUSIONS The third universal definition of MI and the SCAI definition were both associated with significant risk for mortality at 1 year. Suboptimal concordance was observed between ACL and local investigators in identifying patients with PCI complications detected on angiography. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRA·CER] [Study P04736]; NCT00527943; EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome [Study P03684AM2]; NCT00089895).
Collapse
Affiliation(s)
| | | | - Robert M Clare
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul W Armstrong
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gilles Montalescot
- Sorbonne Université Paris 06, ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière (AP-HP), Paris, France
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Philip E Aylward
- South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
37
|
Sibbing D, Aradi D, Alexopoulos D, ten Berg J, Bhatt DL, Bonello L, Collet JP, Cuisset T, Franchi F, Gross L, Gurbel P, Jeong YH, Mehran R, Moliterno DJ, Neumann FJ, Pereira NL, Price MJ, Sabatine MS, So DY, Stone GW, Storey RF, Tantry U, Trenk D, Valgimigli M, Waksman R, Angiolillo DJ. Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1521-1537. [DOI: 10.1016/j.jcin.2019.03.034] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022]
|
38
|
Vogel B, Chandrasekhar J, Baber U, Mastoris I, Sartori S, Aquino M, Krucoff MW, Moliterno DJ, Henry TD, Weisz G, Gibson CM, Iakovou I, Kini AS, Farhan S, Sorrentino S, Faggioni M, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen DJ, Stuckey T, Ariti C, Dangas GD, Pocock S, Mehran R. Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry. Thromb Haemost 2019; 119:1704-1711. [PMID: 31365942 DOI: 10.1055/s-0039-1693463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe. METHODS Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization. RESULTS Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65-1.01, p = 0.065). CONCLUSION DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.
Collapse
Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ioannis Mastoris
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Mitchell W Krucoff
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, United States
| | - Giora Weisz
- Montefiore Medical Center, New York, New York, United States
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Michela Faggioni
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | | | | | | | - David J Cohen
- St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, United States
| | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, United States
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| |
Collapse
|
39
|
Baber U, Li SX, Pinnelas R, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv 2019; 11:e006144. [PMID: 29870385 DOI: 10.1161/circinterventions.117.006144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [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: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
Collapse
Affiliation(s)
- Usman Baber
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Shawn X Li
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Rebecca Pinnelas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Stuart J Pocock
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Mitchell W Krucoff
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Cono Ariti
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - C Michael Gibson
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Philippe Gabriel Steg
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Giora Weisz
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Bernhard Witzenbichler
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Timothy D Henry
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Annapoorna S Kini
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Thomas Stuckey
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Cohen
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Ioannis Iakovou
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - George Dangas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Melissa B Aquino
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Samantha Sartori
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Alaide Chieffo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Moliterno
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Antonio Colombo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Roxana Mehran
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.).
| |
Collapse
|
40
|
Affiliation(s)
- Khaled M Ziada
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - David J Moliterno
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
| |
Collapse
|
41
|
Joyce LC, Baber U, Claessen BE, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, Ariti C, Dangas G, Faggioni M, Aoi S, Gibson CM, Aquino M, Krucoff MW, Vogel B, Moliterno DJ, Sorrentino S, Colombo A, Chieffo A, Kini A, Guedeney P, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age. JACC Cardiovasc Interv 2019; 12:983-992. [DOI: 10.1016/j.jcin.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 01/29/2023]
|
42
|
|
43
|
Faggioni M, Baber U, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, Claessen BE, Dangas GD, Gibson CM, Krucoff MW, Vogel B, Moliterno DJ, Sorrentino S, Colombo A, Chieffo A, Kini A, Farhan S, Ariti C, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007133. [DOI: 10.1161/circinterventions.118.007133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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)
- Michela Faggioni
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
- Department of Internal Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY (M.F.)
| | - Usman Baber
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - David J. Cohen
- Department of Internal Medicine, Section: Cardiovascular Disease, St. Luke’s Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.)
| | - Timothy D. Henry
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Bimmer E. Claessen
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - George D. Dangas
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - C. Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Mitchell W. Krucoff
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC (M.W.K.)
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - David J. Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington (D.J.M.)
| | - Sabato Sorrentino
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - Antonio Colombo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)
| | - Alaide Chieffo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)
| | - Annapoorna Kini
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - Serdar Farhan
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| | - Cono Ariti
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)
| | - Bernard Witzenbichler
- Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.)
| | - Giora Weisz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Montefiore Medical Center, Bronx, New York (G.W.)
| | - Philippe Gabriel Steg
- Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE), University Paris Diderot, Assistance Publique - Hôpitaux de Paris (AP-HP), INSERM U-1148, France (P.G.S.)
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.)
| |
Collapse
|
44
|
Moliterno DJ, Windecker S. Mitral Regurgitation and Evolving Transcatheter Treatments: Insights From the JACC Family of Journals. J Am Coll Cardiol 2019; 73:1353-1357. [PMID: 30898211 DOI: 10.1016/j.jacc.2019.02.011] [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: 11/27/2022]
Affiliation(s)
- David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University of Bern, Bern, Switzerland
| | | |
Collapse
|
45
|
|
46
|
Sorrentino S, Giustino G, Baber U, Sartori S, Cohen DJ, Henry TD, Farhan S, Sharma M, Ariti C, Dangas G, Gibson M, Faggioni M, Krucoff MW, Aquino M, Chandrasekhar J, Moliterno DJ, Colombo A, Vogel B, Chieffo A, Kini AS, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry). Am J Cardiol 2018; 122:1638-1646. [PMID: 30270177 DOI: 10.1016/j.amjcard.2018.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Received: 06/02/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023]
Abstract
The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (pinteraction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.
Collapse
Affiliation(s)
- Sabato Sorrentino
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Gennaro Giustino
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Usman Baber
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samantha Sartori
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David J Cohen
- St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, MN
| | - Serdar Farhan
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Madhav Sharma
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michela Faggioni
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Melissa Aquino
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaya Chandrasekhar
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Antonio Colombo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Birgit Vogel
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alaide Chieffo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Annapoorna S Kini
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Giora Weisz
- Columbia University Medical Center, New York, NY; Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
47
|
|
48
|
Moliterno DJ. Year 1: A Short Look Back and a Long Look Forward. JACC Cardiovasc Interv 2018; 11:1793-1795. [PMID: 30190073 DOI: 10.1016/j.jcin.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
49
|
Angiolillo DJ, Goodman SG, Bhatt DL, Eikelboom JW, Price MJ, Moliterno DJ, Cannon CP, Tanguay JF, Granger CB, Mauri L, Holmes DR, Gibson CM, Faxon DP. Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention. Circulation 2018; 138:527-536. [DOI: 10.1161/circulationaha.118.034722] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [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: 11/16/2022]
Abstract
The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non–vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y
12
inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus–derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
| | - Shaun G. Goodman
- St. Michael’s Hospital, University of Toronto, and the Canadian Heart Research Centre, Canada (S.G.G.)
- Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research Centre, University of Alberta, Canada (S.G.G.)
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., L.M., D.P.F.)
| | - John W. Eikelboom
- Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, Canada (J.W.E.)
| | - Matthew J. Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.)
| | - David J. Moliterno
- Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.)
| | - Christopher P. Cannon
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., L.M., D.P.F.)
| | - Jean-Francois Tanguay
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada (J.-F.T.)
| | | | - Laura Mauri
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., L.M., D.P.F.)
| | | | - C. Michael Gibson
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - David P. Faxon
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., L.M., D.P.F.)
| |
Collapse
|
50
|
Tricoci P, Neely M, Whitley MJ, Edelstein LC, Simon LM, Shaw C, Fortina P, Moliterno DJ, Armstrong PW, Aylward P, White H, Van de Werf F, Jennings LK, Wallentin L, Held C, Harrington RA, Mahaffey KW, Bray PF. Effects of genetic variation in protease activated receptor 4 after an acute coronary syndrome: Analysis from the TRACER trial. Blood Cells Mol Dis 2018; 72:37-43. [PMID: 30055940 DOI: 10.1016/j.bcmd.2018.07.004] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/05/2023]
Abstract
Variation in platelet response to thrombin may affect the safety and efficacy of PAR antagonism. The Thr120 variant of the common single nucleotide polymorphism (SNP) rs773902 in the protease-activated receptor (PAR) 4 gene is associated with higher platelet aggregation compared to the Ala120 variant. We investigated the relationship between the rs773902 SNP with major bleeding and ischemic events, safety, and efficacy of PAR1 inhibition in 6177 NSTE ACS patients in the TRACER trial. There was a lower rate of GUSTO moderate/severe bleeding in patients with the Thr120 variant. The difference was driven by a lower rate in the smaller homozygous group (recessive model, HR 0.13 [0.02-0.92] P = 0.042). No significant differences were observed in the ischemic outcomes. The excess in bleeding observed with PAR1 inhibition was attenuated in patients with the Thr120 variant, but the interactions were not statistically significant. In summary, lower major bleeding rates were observed in the overall TRACER cohort with the hyperreactive PAR4 Thr120 variant. The increase in bleeding with vorapaxar was attenuated with the Thr120 variant, but we could not demonstrate an interaction with PAR1 inhibition. These findings warrant further exploration, including those of African ancestry where the A allele (Thr120) frequency is ~65%.
Collapse
Affiliation(s)
| | - Megan Neely
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael J Whitley
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Leonard C Edelstein
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Lukas M Simon
- Department of Human & Molecular Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chad Shaw
- Department of Human & Molecular Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Statistics, Rice University, Houston, TX, USA
| | - Paolo Fortina
- Cancer Genomics and Bioinformatics Laboratory, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Philip Aylward
- Division of Medicine, Cardiac & Critical Care Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lisa K Jennings
- CirQuest Labs, LLC, and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lars Wallentin
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala, Sweden
| | | | | | - Paul F Bray
- Division of Hematology and Hematologic Malignancies in the Department of Internal Medicine and the Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|