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Mrevlje B, McFadden E, de la Torre Hernández JM, Testa L, De Maria GL, Banning AP, Spitzer E. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in unprotected left main coronary artery disease: A systematic review. Cardiovasc Revasc Med 2024; 59:99-108. [PMID: 37657950 DOI: 10.1016/j.carrev.2023.08.006] [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] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Significant unprotected left main coronary artery (ULMCA) disease is encountered in approximately 5 % of patients undergoing diagnostic coronary angiography. Intravascular ultrasound (IVUS) overcomes many of the known limitations of angiography and improves outcomes of patients undergoing percutaneous coronary interventions (PCI) in stable or complex coronary artery disease. The aim of this systematic review is to evaluate the evidence on IVUS-guidance versus angiography-guidance in ULMCA PCI, highlighting the chronological frequencies of event rates in line with the maturation of PCI technique and devices over time. METHODS A comprehensive systematic search in Medline was performed to identify all studies that had assessed the effect of IVUS-guided versus angiography-guided ULMCA PCI on various primary and secondary endpoints. RESULTS Seventeen studies (2 randomized, 10 non-randomized and 5 meta-analyses) were included in this systematic review. CONCLUSIONS This systematic review on IVUS-guided versus angiography-guided PCI in patients with significant ULMCA disease strongly supports the hypothesis that IVUS-guided PCI is associated with a significant reduction in major adverse cardiac events composites, all-cause death, cardiac death, myocardial infarction and stent thrombosis. Ongoing, adequately powered trials will contribute significantly to the level of evidence.
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Affiliation(s)
| | | | | | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
| | - Giovanni Luigi De Maria
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
| | - Adrian P Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
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2
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Piccolo R, Calabrò P, Varricchio A, Baldi C, Napolitano G, De Simone C, Mauro C, Stabile E, Caiazzo G, Tesorio T, Boccalatte M, Tuccillo B, Bottiglieri G, Russolillo E, Di Lorenzo E, Carrara G, Cassese S, Leonardi S, Biscaglia S, Costa F, McFadden E, Heg D, Franzone A, Stefanini GG, Capodanno D, Esposito G. Rationale and design of the PARTHENOPE trial: A two-by-two factorial comparison of polymer-free vs biodegradable-polymer drug-eluting stents and personalized vs standard duration of dual antiplatelet therapy in all-comers undergoing PCI. Am Heart J 2023; 265:153-160. [PMID: 37572785 DOI: 10.1016/j.ahj.2023.08.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Over the past few decades, percutaneous coronary intervention (PCI) has undergone significant advancements as a result of the combination of device-based and drug-based therapies. These iterations have led to the development of polymer-free drug-eluting stents. However, there is a scarcity of data regarding their clinical performance. Furthermore, while various risk scores have been proposed to determine the optimal duration of dual antiplatelet therapy (DAPT), none of them have undergone prospective validation within the context of randomized trials. DESIGN The PARTHENOPE trial is a phase IV, prospective, randomized, multicenter, investigator-initiated, assessor-blind study being conducted at 14 centers in Italy (NCT04135989). It includes 2,107 all-comers patients with minimal exclusion criteria, randomly assigned in a 2-by-2 design to receive either the Cre8 amphilimus-eluting stent or the SYNERGY everolimus-eluting stent, along with either a personalized or standard duration of DAPT. Personalized DAPT duration is determined by the DAPT score, which accounts for both bleeding and ischemic risks. Patients with a DAPT score <2 (indicating higher bleeding than ischemic risk) receive DAPT for 3 or 6 months for chronic or acute coronary syndrome, respectively, while patients with a DAPT score ≥2 (indicating higher ischemic than bleeding risk) receive DAPT for 24 months. Patients in the standard DAPT group receive DAPT for 12 months. The trial aims to establish the noninferiority between stents with respect to a device-oriented composite end point of cardiovascular death, target-vessel myocardial infarction, or clinically-driven target-lesion revascularization at 12 months after PCI. Additionally, the trial aims to demonstrate the superiority of personalized DAPT compared to a standard approach with respect to a net clinical composite of all-cause death, any myocardial infarction, stroke, urgent target-vessel revascularization, or type 2 to 5 bleeding according to the Bleeding Academic Research Consortium criteria at 24-months after PCI. SUMMARY The PARTHENOPE trial is the largest randomized trial investigating the efficacy and safety of a polymer-free DES with a reservoir technology for drug-release and the first trial evaluating a personalized duration of DAPT based on the DAPT score. The study results will provide novel insights into the optimizing the use of drug-eluting stents and DAPT in patients undergoing PCI.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Attilio Varricchio
- Division of Cardiology, P.O.S. Anna e SS. Madonna della Neve di Boscotrecase, Ospedali Riuniti Area Vesuviana, Naples, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Giovanni Napolitano
- Division of Cardiology, "San Giuliano" Hospital of Giugliano in Campania, Giugliano in Campania, Italy
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Ciro Mauro
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; Division of Cardiology, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Gianluca Caiazzo
- Division of Cardiology, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | | | | | | | | | | | - Salvatore Cassese
- Division of Cardiology, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina, Italy
| | - Eugene McFadden
- Division of Cardiology, Cork University Hospital, Cork, Ireland
| | - Dik Heg
- Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Division of Cardiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
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3
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Segal NA, Nevitt MC, Morales Aquino M, McFadden E, Ho M, Duryea J, Tolstykh I, Cheng H, He J, Lynch JA, Felson DT, Anderson DD. Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study. Osteoarthritis Cartilage 2023; 31:406-413. [PMID: 36526151 PMCID: PMC9974913 DOI: 10.1016/j.joca.2022.12.002] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW. DESIGN Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT). RESULTS Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range: -0.18, -0.24) exceeded that for 2D JSWx (-0.10, -0.16). Responsiveness of 3D JSW subregional mean (-0.06, -0.36) and maximal (-1.14, -1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P ≤ 0.002). CONCLUSIONS Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.
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Affiliation(s)
- N A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | - M C Nevitt
- University of California-San Francisco, San Francisco, CA, USA
| | | | - E McFadden
- The University of Iowa, Iowa City, IA, USA
| | - M Ho
- The University of Iowa, Iowa City, IA, USA
| | - J Duryea
- Harvard University, Cambridge, MA, USA
| | - I Tolstykh
- University of California-San Francisco, San Francisco, CA, USA
| | - H Cheng
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J He
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J A Lynch
- University of California-San Francisco, San Francisco, CA, USA
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4
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Spitzer E, Fanaroff AC, Gibson CM, Seltzer J, McFadden E, Ali M, Wilson M, Menon V, Mehran R, Held C, Mahaffey KW, Lopes RD. Independence of clinical events committees: A consensus statement from clinical research organizations. Am Heart J 2022; 248:120-129. [PMID: 35296411 DOI: 10.1016/j.ahj.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Randomized clinical trials are the gold standard to assess the causal relationship between an intervention and subsequent outcomes, also known as clinical endpoints. In order to limit bias, central clinical events committees (CEC) are established to ensure consistent event reporting across participating centers, as well as complete and accurate ascertainment of endpoints. However, defining independence is challenging. METHODS This consensus statement was generated by teleconferences and electronic communications among clinical research organizations from the United States, Europe and Australia. This document does not constitute regulatory guidance. RESULTS An independent CEC is defined when the adjudicators are not primarily involved in designing, funding, sponsoring, organizing, conducting, analyzing or regulating the clinical trial for which they serve as an adjudicator, beyond their role as CEC member. Moreover, independence requires absence of conflicts of interest with the steering committee, sponsor, grant giver, manufacturer, coordinating center, other independent committees, core laboratories, medical monitor, safety physician, participating clinical sites, statistician or data manager, regulatory agencies or authorities, which could influence (or be perceived to influence) a member's objectivity in evaluating trial data. Such conflicts of interest include financial benefits, directing or advisory role (paid or unpaid), decision-making position, as well as being a direct relative. An independent adjudicator has no other role within a clinical trial. CONCLUSIONS This consensus statement presents a standardized definition of an independent CEC to be considered by clinical research organizations, manufacturers, and investigators. In addition, it provides recommendations on best practices for implementation of an independent CEC.
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Martin D, Gallagher L, Oliveira F, McFadden E, O’Flynn L, O’Dea S. Gene Editing/Gene Therapies: MULTIPLEX GENE EDITING IN T CELLS USING SOLUPORE NON-VIRAL CELL ENGINEERING TECHNOLOGY. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00366-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Sanz-Sánchez J, McFadden E, Garcia-Garcia HM. The Importance of Using the Appropriate Model for Systematic Reviews and Meta-analyses. JAMA Intern Med 2022; 182:357. [PMID: 35099524 DOI: 10.1001/jamainternmed.2021.8135] [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: 11/14/2022]
Affiliation(s)
- Jorge Sanz-Sánchez
- Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomedica en Red, Madrid, Spain
| | | | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.,Georgetown University School of Medicine, Washington, DC
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7
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Kerkmeijer LS, Tijssen R, Hofma S, van der Schaaf R, Arkenbout EK, Weevers A, Garcia-Garcia H, McFadden E, Piek J, de Winter R, Tijssen J, Henriques J, Wykrzykowska J. Four-Year Follow-Up of Absorb BVS Compared to Xience EES in Daily Clinical Practice Shows Continued Accrual of Events. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.075] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Leonardi S, Branca M, Franzone A, McFadden E, Piccolo R, Jüni P, Vranckx P, Steg PG, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Heg D, Windecker S, Valgimigli M. Comparison of Investigator-Reported and Clinical Event Committee-Adjudicated Outcome Events in GLASSY. Circ Cardiovasc Qual Outcomes 2021; 14:e006581. [PMID: 33535773 DOI: 10.1161/circoutcomes.120.006581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
BACKGROUND Event adjudication by a clinical event committee (CEC) provides a standardized, independent outcome assessment. However, the added value of CEC to investigators reporting remains debated. GLASSY (GLOBAL LEADERS Adjudication Sub-Study) implemented, in a subset of the open-label, investigator-reported (IR) GLOBAL LEADERS trial, an independent adjudication process of reported and unreported potential outcome events (triggers). We describe metrics of GLASSY feasibility and efficiency, diagnostic accuracy of IR events, and their concordance with corresponding CEC-adjudicated events. METHODS We report the proportion of myocardial infarction, bleeding, stroke, and stent thrombosis triggers with sufficient evidence for assessment (feasibility) that were adjudicated as outcome events (efficiency), stratified by source (IR or non-IR). Using CEC-adjudicated events as criterion standard, we describe sensitivity, specificity, positive and negative predictive value, and global diagnostic accuracy of IR events. Using Gwet AC coefficient, we examine the concordance between IR- and corresponding CEC-adjudicated triggers. There was sufficient evidence for assessment for 2592 (98.3%) of 2636 triggers. RESULTS Overall, the adjudicated end point-to-trigger ratio was high and similar between IR- (88%) and non-IR-reported (87%) triggers. The global diagnostic accuracy and concordance between IR-reported and CEC-adjudicated outcome events was 0.70 (95% CI, 0.65-0.74) and 0.54 (95% CI, 0.45-0.62), respectively, for myocardial infarction; 0.77 (95% CI, 0.75-0.79) and 0.71 (95% CI, 0.68-0.74) for bleeding; 0.70 (95% CI, 0.62-0.79) and 0.59 (95% CI, 0.43-0.74) for stroke; 0.59 (95% CI, 0.52-0.66) and 0.39 (95% CI, 0.25-0.53) for stent thrombosis. For IR bleedings, the concordance with the CEC on type of events was generally weak. CONCLUSIONS Implementing CEC adjudication in a pragmatic open-label trial with IR events is feasible and efficient. Our findings of modest global diagnostic accuracy for IR events and generally weak concordance between investigators and CEC support the role for CEC adjudication in such settings. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03231059.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Italy (S.L.).,Coronary Care Unit (S.L.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Mattia Branca
- Clinical Trials Unit Bern (M.B.), University of Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Eugene McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands (E.M.).,Department of Cardiology, Cork University Hospital, Ireland (E.M.)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Peter Jüni
- Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada (P.J.)
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium (P.V.)
| | | | - Patrick W Serruys
- Department of Cardiology, Imperial College of London, United Kingdom (P.W.S.)
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium (E.B.)
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.)
| | - Luc Janssens
- German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Maurizio Ferrario
- Division of Cardiology (M.F.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Department of Interventional Cardiology, American Heart of Poland SA, Chrzanów (A.Z.)
| | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (R.D.)
| | | | - Kurt Huber
- 3rd Medical Department, Cardiology, Wilhelminen Hospital, Vienna, Austria (K.H.)
| | - Ton Slagboom
- Sigmund Freud University Medical School, Vienna, Austria (K.H.)
| | - Pawel Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Ustroń (P.B.).,Department of Epidemiology and Statistics, Medical University of Silesia, Katowice, Poland (P.B.)
| | | | - Carlo Tumscitz
- Cardiology Unit Sant'Anna Hospital, Ferrara, Italy (C.T.)
| | - Krzysztof Bryniarski
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (K.B.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria (I.P.)
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom (S.G.)
| | - Cristoph Naber
- Contilia Heart and Vascular Centre, Stadtspital Triemli, Zürich, Switzerland (C.N.)
| | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.).,German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H.), University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland (M. Valgimigli)
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9
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Spitzer E, Ren B, Brugts JJ, Daemen J, McFadden E, Tijssen JG, Van Mieghem NM. Cardiovascular Clinical Trials in a Pandemic: Immediate Implications of Coronavirus Disease 2019. Card Fail Rev 2020; 6:e09. [PMID: 32411396 PMCID: PMC7215493 DOI: 10.15420/cfr.2020.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic started in Wuhan, Hubei Province, China, in December 2019, and by 24 April 2020, it had affected >2.73 million people in 185 countries and caused >192,000 deaths. Despite diverse societal measures to reduce transmission of the severe acute respiratory syndrome coronavirus 2, such as implementing social distancing, quarantine, curfews and total lockdowns, its control remains challenging. Healthcare practitioners are at the frontline of defence against the virus, with increasing institutional and governmental supports. Nevertheless, new or ongoing clinical trials, not related to the disease itself, remain important for the development of new therapies, and require interactions among patients, clinicians and research personnel, which is challenging, given isolation measures. In this article, the authors summarise the acute effects and consequences of the COVID-19 pandemic on current cardiovascular trials.
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Affiliation(s)
- Ernest Spitzer
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands
| | - Ben Ren
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands
| | - Eugene McFadden
- Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands.,Department of Cardiology, Cork University Hospital Cork, Ireland
| | - Jan Gp Tijssen
- Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands.,Amsterdam University Medical Centers, University of Amsterdam Amsterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories Rotterdam, the Netherlands
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10
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Spitzer E, McFadden E, Rademaker-Havinga T, Cutlip DE, Garcia-Garcia HM. Reply: Periprocedural PCI Myocardial Biomarker Elevation and Mortality. JACC Cardiovasc Interv 2020; 13:266-268. [PMID: 31973800 DOI: 10.1016/j.jcin.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
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11
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Lansky AJ, Messé SR, Brickman AM, Dwyer M, Bart van der Worp H, Lazar RM, Pietras CG, Abrams KJ, McFadden E, Petersen NH, Browndyke J, Prendergast B, Ng VG, Cutlip DE, Kapadia S, Krucoff MW, Linke A, Scala Moy C, Schofer J, van Es GA, Virmani R, Popma J, Parides MK, Kodali S, Bilello M, Zivadinov R, Akar J, Furie KL, Gress D, Voros S, Moses J, Greer D, Forrest JK, Holmes D, Kappetein AP, Mack M, Baumbach A. Proposed Standardized Neurological Endpoints for Cardiovascular Clinical Trials: An Academic Research Consortium Initiative. Eur Heart J 2019; 39:1687-1697. [PMID: 28171522 DOI: 10.1093/eurheartj/ehx037] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 01/06/2023] Open
Abstract
Surgical and catheter-based cardiovascular procedures and adjunctive pharmacology have an inherent risk of neurological complications. The current diversity of neurological endpoint definitions and ascertainment methods in clinical trials has led to uncertainties in the neurological risk attributable to cardiovascular procedures and inconsistent evaluation of therapies intended to prevent or mitigate neurological injury. Benefit-risk assessment of such procedures should be on the basis of an evaluation of well-defined neurological outcomes that are ascertained with consistent methods and capture the full spectrum of neurovascular injury and its clinical effect. The Neurologic Academic Research Consortium is an international collaboration intended to establish consensus on the definition, classification, and assessment of neurological endpoints applicable to clinical trials of a broad range of cardiovascular interventions. Systematic application of the proposed definitions and assessments will improve our ability to evaluate the risks of cardiovascular procedures and the safety and effectiveness of preventive therapies.
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Affiliation(s)
- Alexandra J Lansky
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut.,Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Brickman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald M Lazar
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cody G Pietras
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Kevin J Abrams
- Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida
| | - Eugene McFadden
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey Browndyke
- Division of Geriatric Behavioral Health, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | | | - Vivian G Ng
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Donald E Cutlip
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitchell W Krucoff
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Claudia Scala Moy
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Interventions of Structural Heart Disease, Albertine Heart Center, Hamburg, Germany
| | | | | | - Jeffrey Popma
- Icahn School of Medicine at Mount Sinai Group, New York, New York
| | | | - Susheel Kodali
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - Michel Bilello
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - Joseph Akar
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Providence, Rhode Island
| | - Daryl Gress
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Szilard Voros
- Global Institute for Research and Global Genomics Group, Richmond, Virginia
| | - Jeffrey Moses
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - David Greer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Arie P Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; and the
| | - Michael Mack
- Department of Cardiovascular Surgery, The Heart Hospital Baylor Plano Research Center, Plano Texas. Grants to support travel costs, meeting rooms, and lodging for academic attendees at the San Francisco and New York meetings were provided by Boston Scientific, Edwards Lifesciences, Medtronic Corporation, St. Jude Medical, NeuroSave Inc., and Keystone Heart Ltd
| | - Andreas Baumbach
- Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom
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12
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Valdes-Chavarri M, Kedev S, Neskovic AN, Morís de la Tassa C, Zivkovic M, Trillo Nouche R, Vázquez González N, Bartorelli AL, Antoniucci D, Tamburino C, Colombo A, Abizaid AA, McFadden E, Garcia-Garcia HM, Milasinovic D, Stankovic G. Randomised evaluation of a novel biodegradable polymer-based sirolimus-eluting stent in ST-segment elevation myocardial infarction: the MASTER study. EUROINTERVENTION 2019; 14:e1836-e1842. [PMID: 29957593 DOI: 10.4244/eij-d-17-01087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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
AIMS The MASTER study was designed to compare the performance of a new biodegradable polymer sirolimus-eluting stent (BP-SES) with a bare metal stent (BMS) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS The study was a prospective, randomised (3:1), controlled, single-blind multicentre trial that enrolled 500 STEMI patients within 24 hours of symptom onset during 2013-2015. Three hundred and seventy-five patients were treated with BP-SES and 125 with BMS. One hundred and four (104) randomised patients underwent angiographic follow-up at six months. The primary clinical endpoint was target vessel failure (TVF), defined as cardiac death, MI not clearly attributable to a non-target vessel, or clinically driven target vessel revascularisation (TVR) at 12 months. The primary angiographic endpoint was in-stent late lumen loss (LLL) at six months in the angiographic cohort. The major secondary endpoint for safety was a composite of all-cause death, recurrent MI, unplanned infarct-related artery revascularisation, stroke, definite stent thrombosis (ST) or major bleeding at one month. At 12 months, TVF had occurred in 6.1% of BP-SES and 14.4% of BMS patients (pnon-inferiority=0.0004), mainly driven by a higher rate of repeat revascularisation in BMS patients. The safety endpoint occurred in 3.5% of BP-SES and 7.2% of BMS patients (p=0.127). In-stent LLL demonstrated the superiority (p=0.0125) of BP-SES (0.09±0.43 mm) over BMS (0.79±0.67 mm). CONCLUSIONS The study showed clinical non-inferiority and angiographic superiority of BP-SES versus a comparator BMS, suggesting that this novel DES may be a potential treatment option in STEMI.
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13
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Leonardi S, Franzone A, Piccolo R, McFadden E, Vranckx P, Serruys P, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, van Geuns RJ, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg G, Heg D, Juni P, Windecker S, Valgimigli M. Rationale and design of a prospective substudy of clinical endpoint adjudication processes within an investigator-reported randomised controlled trial in patients with coronary artery disease: the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY). BMJ Open 2019; 9:e026053. [PMID: 30852547 PMCID: PMC6429932 DOI: 10.1136/bmjopen-2018-026053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias. METHODS AND ANALYSIS We designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90 mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months followed by aspirin monotherapy for the primary efficacy endpoint of death, non-fatal myocardial infarction, non-fatal stroke or urgent target vessel revascularisation and superior for the primary safety endpoint of type 3 or 5 bleeding according to the Bleeding Academic Research Consortium criteria.This study will comprehensively assess the comparative safety and efficacy of the two tested antithrombotic strategies on CEC-adjudicated ischaemic and bleeding endpoints and will provide insights into the role of a standardised CEC adjudication process on the interpretation of study findings by quantifying the level of concordance between IR-reported and CEC-adjudicated events. ETHICS AND DISSEMINATION GLASSY has been approved by local ethics committee of all study sites and/or by the central ethics committee for the country depending on country-specific regulations. In all cases, they deemed that it was not necessary to obtain further informed consent from individual subjects. TRIAL REGISTRATION NUMBER NCT01813435.
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Affiliation(s)
- Sergio Leonardi
- University of Pavia, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Eugene McFadden
- Department of Cardiology, Cork University Hospital Group, Cork, Ireland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Hasselt, Belgium
| | - Patrick Serruys
- Department of Cardiology, Imperial College of London, London, UK
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Luc Janssens
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Maurizio Ferrario
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | - Marcello Dominici
- Department of Cardiology, S. Maria University-Hospital, Terni, Italy
| | - Kurt Huber
- 3rd Med Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
| | - Ton Slagboom
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - Paweł Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Poland, Poland
| | | | - Carlo Tumscitz
- Department of Cardiology, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Italy
| | - Krzysztof Bryniarski
- Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ivo Petrov
- Department of Cardiology, Adzhibadem Siti Klinik Surdechno-sudovi Center, Sofia, Bulgaria
| | - Scot Garg
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christoph Naber
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre, Essen, Germany
| | | | | | - Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Dik Heg
- CTU, Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern, Switzerland
| | - Peter Juni
- Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland
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14
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Cano ES, Chichareon P, McFadden E, Modolo R, Takahashi K, Chang CC, Kogame N, Katagiri Y, Hoole S, Gori T, Zaman A, Frey B, Ferreira RC, Bertrand OF, Yap SC, Steg P, Hamm C, Jüni P, Vranckx P, Valgimigli M, Windecker S, Serruys P, Onuma Y, Soliman O. CORE LABORATORY ASSESSMENT OF NON-FATAL Q-WAVE MYOCARDIAL INFARCTION IN THE GLOBAL LEADERS TRIAL: METHODS AND FINDINGS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30863-0] [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: 10/27/2022]
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15
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Spitzer E, McFadden E, Onuma Y, Serruys PW. Reply: Following Renal Outcomes With Staging in Percutaneous Coronary Intervention Trials. JACC Cardiovasc Interv 2018; 11:1662-1663. [PMID: 30139478 DOI: 10.1016/j.jcin.2018.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
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16
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Rourke TA, McFadden E, Rogers ACN. Computer-assisted Control of a Waiting List. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The main objective in the use of computer-based systems which dynamically order hospital waiting lists is to produce a more systematic and clinically acceptable pattern of selection from the waiting list than that resulting from traditional manual systems. This has been achieved previously through the evaluation of fairly complex mathematical formulae which require detailed analysis to modify their behaviour pattern, and thus separate the clinician from direct control of the system.This paper describes a waiting list management system which uses a conceptually simple ordering process based on waiting time limits set by the clinician for each planned clinical procedure relevant to the specialty. The clinician receives periodic analyses of the current performance of the process and can easily control the behaviour pattern by changing the limits for any procedure. The system also keeps account of allocated bed and theatre resources.Use of this waiting list management system in a Urology Department has resulted in a significant shift in the composition of the waiting list and in a more equitable pattern of selection from the waiting list;. In addition, the time spent by the clinician in managing the waiting list has been considerably reduced.
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17
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Poovelikunnel TT, Gethin G, Solanki D, McFadden E, Codd M, Humphreys H. Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2017; 98:141-148. [PMID: 29107078 DOI: 10.1016/j.jhin.2017.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mupirocin is used specifically for the eradication of nasal meticillin-resistant Staphylococcus aureus (MRSA), but increasing mupirocin resistance restricts its repeated use. The antibacterial effects of manuka honey have been established in vitro; antibacterial activity of other honeys has also been reported. AIM To describe the learning experience from a randomized controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal MRSA. METHODS Patients colonized in the nose with MRSA and age ≥18 years were recruited. Participants received either one or two courses of MGH or mupirocin 2%, three times per day for five consecutive days. FINDINGS The proportion of patients who were decolonized after one or two courses of treatment was not significantly different between MGH [18/42; 42.8%; 95% confidence interval (CI): 27.7-59.0] and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0-71.7). Non-nasal MRSA colonization was significantly associated with persistent nasal colonization (odds ratio: 5.186; 95% CI: 1.736-5.489; P = 0.003). The rate of new acquisition of mupirocin resistance was 9.75%. CONCLUSION Although not significant, a decolonization rate of 42.8% for MGH was impressive. Our findings suggest that this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies.
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Affiliation(s)
- T T Poovelikunnel
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
| | - G Gethin
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland, Galway, Ireland
| | - D Solanki
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Microbiology Department, Beaumont Hospital, Dublin, Ireland
| | - M Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - H Humphreys
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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18
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Tutt A, Kaufman B, Garber J, Gelber R, McFadden E, Goessl C, Viale G, Geyer C, Zardavas D, Arahmani A, Fumagalli D, De Azambuja E, Ponde N, Herbolsheimer P, Wu W, Constantino J, Rastogi P. OlympiA: A randomized phase III trial of olaparib as adjuvant therapy in patients with high-risk HER2-negative breast cancer (BC) and a germline BRCA1/2 mutation (gBRCAm). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Caplice N, Devoe M, Choi J, Dahly D, Spitzer E, Van Guens R, Maher M, Tuite D, Kerins D, Kelly P, Kearney P, Curtin R, Vaughan C, Eustace J, McFadden E. P2125Randomised placebo controlled trial evaluating the safety and efficacy of intracoronary insulin like growth factor 1 post percutaneous intervention for acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2125] [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: 11/14/2022] Open
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20
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Lansky AJ, Messé SR, Brickman AM, Dwyer M, van der Worp HB, Lazar RM, Pietras CG, Abrams KJ, McFadden E, Petersen NH, Browndyke J, Prendergast B, Ng VG, Cutlip DE, Kapadia S, Krucoff MW, Linke A, Moy CS, Schofer J, van Es GA, Virmani R, Popma J, Parides MK, Kodali S, Bilello M, Zivadinov R, Akar J, Furie KL, Gress D, Voros S, Moses J, Greer D, Forrest JK, Holmes D, Kappetein AP, Mack M, Baumbach A. Proposed Standardized Neurological Endpoints for Cardiovascular Clinical Trials: An Academic Research Consortium Initiative. J Am Coll Cardiol 2017; 69:679-691. [PMID: 28183511 DOI: 10.1016/j.jacc.2016.11.045] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
Abstract
Surgical and catheter-based cardiovascular procedures and adjunctive pharmacology have an inherent risk of neurological complications. The current diversity of neurological endpoint definitions and ascertainment methods in clinical trials has led to uncertainties in the neurological risk attributable to cardiovascular procedures and inconsistent evaluation of therapies intended to prevent or mitigate neurological injury. Benefit-risk assessment of such procedures should be on the basis of an evaluation of well-defined neurological outcomes that are ascertained with consistent methods and capture the full spectrum of neurovascular injury and its clinical effect. The Neurologic Academic Research Consortium is an international collaboration intended to establish consensus on the definition, classification, and assessment of neurological endpoints applicable to clinical trials of a broad range of cardiovascular interventions. Systematic application of the proposed definitions and assessments will improve our ability to evaluate the risks of cardiovascular procedures and the safety and effectiveness of preventive therapies.
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Affiliation(s)
- Alexandra J Lansky
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, New Haven, Connecticut; Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom.
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Brickman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald M Lazar
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cody G Pietras
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Kevin J Abrams
- Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida
| | - Eugene McFadden
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey Browndyke
- Division of Geriatric Behavioral Health, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | | | - Vivian G Ng
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, New Haven, Connecticut
| | - Donald E Cutlip
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitchell W Krucoff
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Claudia Scala Moy
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Interventions of Structural Heart Disease, Albertine Heart Center, Hamburg, Germany
| | | | | | - Jeffrey Popma
- Icahn School of Medicine at Mount Sinai Group, New York, New York
| | | | - Susheel Kodali
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - Michel Bilello
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis, University of Buffalo, Buffalo, New York
| | - Joseph Akar
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Providence, Rhode Island
| | - Daryl Gress
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Szilard Voros
- Global Institute for Research and Global Genomics Group, Richmond, Virginia
| | - Jeffrey Moses
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - David Greer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Arie P Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michael Mack
- Department of Cardiovascular Surgery, The Heart Hospital Baylor Plano Research Center, Plano Texas
| | - Andreas Baumbach
- Department of Cardiology, St Bartholomew's Hospital, William Harvey Research Institute, and Queen Mary University of London, London, United Kingdom
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21
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Spitzer E, de Vries T, Cavalcante R, Tuinman M, Rademaker-Havinga T, Alkema M, Morel MA, Soliman OI, Onuma Y, van Es GA, Tijssen JG, McFadden E, Serruys PW. Detecting Periprocedural Myocardial Infarction in Contemporary Percutaneous Coronary Intervention Trials. JACC Cardiovasc Interv 2017; 10:658-666. [DOI: 10.1016/j.jcin.2016.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
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22
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Ryan P, Skally M, Duffy F, Farrelly M, Gaughan L, Flood P, McFadden E, Fitzpatrick F. Evaluation of fixed and variable hospital costs due to Clostridium difficile infection: institutional incentives and directions for future research. J Hosp Infect 2017; 95:415-420. [PMID: 28320542 DOI: 10.1016/j.jhin.2017.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished. AIM To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015. METHODS A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure. FINDINGS The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included). CONCLUSION As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making.
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Affiliation(s)
- P Ryan
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - M Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - M Farrelly
- Department of Finance, Beaumont Hospital, Dublin, Ireland
| | - L Gaughan
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - P Flood
- General Services Department, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
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Abstract
Disease specific quality of life was measured in the Leeds Multiple Sclerosis (MS) Treatment Programme (n-/210) using the self-report Leeds MS Quality of Life (LMSQoL) scale. The results showed a significant and sustained increase in quality of life associated with ‘disease modifying’ treatment. This contrasts with the Expanded Disability Status Scores (EDSS), which showed no measurable improvement. An increase in the LMSQoL score did not correlate with baseline age, disease duration, disability or number of prior relapses. There was no significant difference in treatment effect between relapsing-remitting and secondary progressive MS patients, or between patients receiving different products. However, patients with a poor quality of life at baseline showed the most benefit from treatment. Those who had their treatment stopped due to progression, side-effects or lack of effect had significantly lower LMSQoL scores on treatment. In this study, the LMSQoL scale was responsive to change and was easy to administer in a clinical setting.
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Affiliation(s)
- O Lily
- Neurosciences Centre, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Secemsky EA, Matteau A, Yeh RW, Steg PG, Camenzind E, Wijns W, McFadden E, Mauri L. Comparison of Short- and Long-Term Cardiac Mortality in Early Versus Late Stent Thrombosis (from Pooled PROTECT Trials). Am J Cardiol 2015; 115:1678-84. [PMID: 25910523 DOI: 10.1016/j.amjcard.2015.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/26/2022]
Abstract
Studies have indicated varying mortality risks with timing of stent thrombosis (ST), but few have been adequately powered with prospective late follow-up. PROTECT randomized 8,709 subjects to either Endeavor zotarolimus-eluting or Cypher sirolimus-eluting stents. PROTECT Continued Access enrolled 1,018 patients treated with Endeavor zotarolimus-eluting stents. Subjects completed at least 4 and 3 years of follow-up, respectively. ARC-defined definite and probable ST events were stratified by time from index procedure: early (≤30 days), late (>30 and ≤360 days), and very late (>360 days). Rates of death and myocardial infarction were analyzed by ST timing. Median follow-up was 4.1 years. There were 184 ST events (1.9%): 61 early, 27 late, and 96 very late. Patient and procedural characteristics were similar between timing groups. There was no difference in dual-antiplatelet therapy use at discharge (97%) or 1 year (84%). Cardiac death in patients with ST at 4 years occurred in 32.1% compared with 2.5% in patients without ST (p <0.001). Combined rates of cardiac death and myocardial infarction did not differ according to ST timing, yet early ST was more commonly associated with cardiac death at 4 years than later ST (50.8% for early vs 18.5% for late vs 24.0% for very late; p <0.001). The relation between ST timing and outcomes did not differ between stent types. In conclusion, in prospective data, cardiac death was more common after early ST than later ST. Although ST remains infrequent, continued efforts to determine how to reduce ST, particularly within the first 30 days, are warranted. (The PROTECT trial is registered with ClinicalTrials.gov, number NCT00476957.).
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Valgimigli M, Patialiakas A, Thury A, McFadden E, Colangelo S, Campo G, Tebaldi M, Ungi I, Tondi S, Roffi M, Menozzi A, de Cesare N, Garbo R, Meliga E, Testa L, Gabriel HM, Airoldi F, Ferlini M, Liistro F, Dellavalle A, Vranckx P, Briguori C. Zotarolimus-Eluting Versus Bare-Metal Stents in Uncertain Drug-Eluting Stent Candidates. J Am Coll Cardiol 2015; 65:805-815. [DOI: 10.1016/j.jacc.2014.11.053] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 12/23/2022]
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Rodriguez-Granillo GA, Rodriguez AE, Bruining N, Milei J, Aoki J, Tsuchida K, del Valle-Fernández R, Arampatzis CA, Ong ATL, Lemos PA, Ayala F, Garcia-Garcia HM, Saia F, Valgimigli M, Regar E, McFadden E, Biondi-Zoccai G, Barbenza E, Schoenhagen P, Serruys PW. Quantification of scientific output in cardiovascular medicine: a perspective based on global data. EUROINTERVENTION 2014; 9:975-8. [PMID: 24063871 DOI: 10.4244/eijv9i8a163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/05/2023]
Abstract
AIMS We sought to explore whether global and regional scientific output in cardiovascular medicine is associated with economic variables and follows the same trend as medicine and as science overall. METHODS AND RESULTS We registered the number of documents, number of citations, citations per document and the h-index for the first 50 countries according to the h-index (a measure to evaluate both the productivity and impact of the publications) in cardiovascular medicine. Economic variables (gross domestic product [GDP] per capita, % expenditure of the GDP in research and development [R&D] and health) were obtained from the World Bank, the UNESCO, and the World Health Organization. In total, the scientific output in cardiology showed the same position as in medicine and science overall (mean difference vs. medicine -0.9±5.3º, p=0.25 vs. science -0.7±5.3º, p=0.39). We found significant correlations between the h-index and the % GDP expenditure in R&D (r=0.67, p<0.001), and the % GDP expenditure in health (r=0.71, p<0.0001). Overall, there was a 21.4% (interquartile range 3.7; 55.0) increase in the % GDP expenditure in R&D between 1996 and 2007. Emerging economies showed the larger growth in % GDP expenditure in health and R&D. CONCLUSIONS The global situation of scientific output in cardiovascular medicine is highly polarised and closely related to economic indicators. Emergent economies, with higher rates of GDP growth and increasingly larger expenditures for R&D and healthcare, are expected to show a visible escalation in the scientific global picture in the near future.
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Cooke J, Murphy T, McFadden E, O'Reilly M, Cahill MR. Can mean platelet component be used as an index of platelet activity in stable coronary artery disease? Hematology 2013; 14:111-4. [DOI: 10.1179/102453309x385160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- John Cooke
- Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland
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Abstract
Critical coronary stenoses accounts for a small proportion of acute coronary syndromes and sudden death. The majority are caused by coronary thromboses that arise from a nonangiographically obstructive atheroma. Recent developments in noninvasive imaging of so-called vulnerable plaques created opportunities to direct treatment to prevent morbidity and mortality associated with these high-risk lesions. This review covers therapy employed in the past, present, and potentially in the future as the natural history of plaque assessment unfolds.
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Affiliation(s)
- Sazzli Kasim
- Cardiology Unit, Medical Faculty, UiTM Sg Buloh, Selangor, Malaysia ; Division of Cardiology, Cork University Hospital, Cork, Ireland
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Camenzind E, Wijns W, Mauri L, Kurowski V, Parikh K, Gao R, Bode C, Greenwood JP, Boersma E, Vranckx P, McFadden E, Serruys PW, O'Neil WW, Jorissen B, Van Leeuwen F, Steg PG. Stent thrombosis and major clinical events at 3 years after zotarolimus-eluting or sirolimus-eluting coronary stent implantation: a randomised, multicentre, open-label, controlled trial. Lancet 2012; 380:1396-405. [PMID: 22951082 DOI: 10.1016/s0140-6736(12)61336-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND We sought to compare the long-term safety of two devices with different antiproliferative properties: the Endeavor zotarolimus-eluting stent (E-ZES; Medtronic, Inc) and the Cypher sirolimus-eluting stent (C-SES; Cordis, Johnson & Johnson) in a broad group of patients and lesions. METHODS Between May 21, 2007 and Dec 22, 2008, we recruited 8791 patients from 36 recruiting countries to participate in this open-label, multicentre, randomised, superiority trial. Eligible patients were those aged 18 years or older undergoing elective, unplanned, or emergency procedures in native coronary arteries. Patients were randomly assigned to either receive E-ZES and C-SES (ratio 1:1). Randomisation was stratified per centre with varying block sizes of four, six, or eight patients, and concealed with a central telephone-based or web-based allocation service. The primary outcome was definite or probable stent thrombosis at 3 years and was analysed by intention to treat. Patients and investigators were aware of treatment assignment. This trial is registered with ClinicalTrials.gov, number NCT00476957. FINDINGS PROTECT randomised 8791 patients, of whom 8709 provided consent to participate and were eligible: 4357 were allocated to the E-ZES group and 4352 patients to the C-SES group. At 3 years, rates of definite or probable stent thrombosis did not differ between groups (1·4% for E-ZES [predicted: 1·5%] vs 1·8% [predicted: 2·5%] for C-SES; hazard ratio [HR] 0·81, 95% CI 0·58-1·14, p=0·22). Dual antiplatelet therapy was used in 8402 (96%) patients at discharge, 7456 (88%) at 1 year, 3041 (37%) at 2 years, and 2364 (30%) at 3 years. INTERPRETATION No evidence of superiority of E-ZES compared with C-SES in definite or probable stent thrombosis rates was noted at 3 years. Time analysis suggests a difference in definite or probable stent thrombosis between groups is emerging over time, and a longer follow-up is therefore needed given the clinical relevance of stent thrombosis. FUNDING Medtronic, Inc.
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Vranckx P, McFadden E, Mehran R, Cutlip DE. Clinical event committees in coronary stent trials: insights and recommendations based on experience in an unselected study population. EUROINTERVENTION 2012; 8:368-74. [DOI: 10.4244/eijv8i3a56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kedhi E, Gomes M, Joesoef K, Wassing J, Goedhart D, McFadden E, Smits PC. Everolimus-eluting stents and paclitaxel-eluting stents in patients presenting with myocardial infarction: insights from the two-year results of the COMPARE prospective randomised controlled trial. EUROINTERVENTION 2012; 7:1376-85. [DOI: 10.4244/eijv7i12a217] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mollet N, Maffei E, Martini C, Weustink A, van Mieghem C, Baks T, McFadden E, de Feyter P, Catalano O, Seitun S, Krestin G, Cademartiri F. Coronary plaque burden in patients with stable and unstable coronary artery disease using multislice CT coronary angiography. Radiol Med 2011; 116:1174-87. [PMID: 21892712 DOI: 10.1007/s11547-011-0722-5] [Citation(s) in RCA: 3] [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] [Received: 05/18/2009] [Accepted: 07/08/2009] [Indexed: 01/27/2023]
Abstract
PURPOSE We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris. MATERIALS AND METHODS Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS). RESULTS Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05). CONCLUSIONS MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
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Affiliation(s)
- N Mollet
- Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Smits PC, Kedhi E, Royaards KJ, Joesoef KS, Wassing J, Rademaker-Havinga TAM, McFadden E. 2-year follow-up of a randomized controlled trial of everolimus- and paclitaxel-eluting stents for coronary revascularization in daily practice. COMPARE (Comparison of the everolimus eluting XIENCE-V stent with the paclitaxel eluting TAXUS LIBERTÉ stent in all-comers: a randomized open label trial). J Am Coll Cardiol 2011; 58:11-8. [PMID: 21514083 DOI: 10.1016/j.jacc.2011.02.023] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [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: 12/07/2010] [Revised: 02/04/2011] [Accepted: 02/22/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the safety and efficacy of the Xience V (Abbott Vascular, Santa Clara, California) everolimus-eluting stent (EES) with the Taxus Liberté (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stent (PES) at 2-year follow-up. BACKGROUND COMPARE (Comparison of the everolimus eluting XIENCE-V stent with the paclitaxel eluting TAXUS LIBERTÉ stent in all-comers: a randomized open label trial) demonstrated a superior clinical outcome of EES over PES at 1 year in all comers. Whether this superiority is maintained after discontinuation, at 12 months, of dual antiplatelet therapy is unclear. METHODS Patients undergoing percutaneous coronary intervention with limited exclusion criteria were randomly allocated to EES or PES. The 2-year pre-specified endpoints are composites of safety and efficacy and stent thrombosis. RESULTS Follow-up was completed in 1,795 of 1,800 patients (99.7%). The groups had similar baseline characteristics. At 2 years, significantly fewer EES patients took dual antiplatelet therapy (11.4% vs. 15.4%, p = 0.02). The primary composite of all death, nonfatal myocardial infarction, and target vessel revascularization occurred in 9.0% of EES patients and 13.7% of PES patients (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.50 to 0.86) driven by a lower rate of myocardial infarction (3.9% vs. 7.5%; RR: 0.52; 95% CI: 0.35 to 0.77) and target vessel revascularization (3.2% vs. 8.0%; RR: 0.41; 95% CI: 0.27 to 0.62), in parallel with a lower rate of definite or probable stent thrombosis (0.9% vs. 3.9%; RR: 0.23; 95% CI: 0.11 to 0.49). Differences significantly increased between 1- and 2-year follow-up for the primary composite endpoint (p = 0.04), target vessel revascularization (p = 0.02), and definite or probable stent thrombosis (p = 0.02). CONCLUSIONS The substantial clinical benefit of the EES over the PES with regard to measures of both safety and efficacy is maintained at 2 years in real-life practice with an increasing benefit in terms of safety and efficacy between 1 year and 2 years.
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Affiliation(s)
- Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Groene Hilledijk 315, Rotterdam, the Netherlands.
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Kasim S, Moran D, Curtin R, Kearney P, McFadden E, Kiernan T. P083 Long Term Outcome of the Second Generation Drug Eluting Stent in the Real World Setting – Paclitaxel Versus Zotarolimus. Int J Cardiol 2011. [DOI: 10.1016/s0167-5273(11)70043-2] [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]
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Hynes B, Dollard J, Murphy G, O'Sullivan J, Ruggiero N, Margey R, Kiernan TJ, McFadden E. Enhancing back-up support during difficult coronary stent delivery: single-center case series of experience with the Heartrail II catheter. J Invasive Cardiol 2011; 23:E43-E46. [PMID: 21364247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite continued advances in creating lower-profile intracoronary balloons and stents, technical difficulties with stent deliverability are frequently encountered. Recent advances in catheter design have yielded soft ended atraumatic catheters for use within standard guide catheters - the so called double coaxial guiding catheter technique. We report our preliminary experience using the 5 Fr Terumo guide catheter (Heartrail II, Terumo) from a single center. METHODS We describe six percutaneous coronary intervention (PCI) procedures where stent deployment initially failed during the standard approach. Subsequent utilization of this 5 Fr catheter system within a standard 6 Fr guide facilitated successful procedural outcomes. This catheter system facilitated non-traumatic deep intubation and stent delivery beyond the site of obstruction encountered during PCI of the distal right coronary and left anterior descending arteries. RESULTS 3 males and 3 females with a mean age of 72.5 ± 5.4 years underwent PCI using the Heartrail II catheter. Patient and procedural characteristics are summarized in Table 1. The intracoronary catheter was inserted into 3 right coronary arteries, 2 left circumflex arteries and 1 left anterior descending artery. Classification of discrete lesions yielded 6 type C lesions. The mean number of stents deployed was 3.33 ± 0.80 with a mean procedure X-ray screening duration of 35.04 ± 7.79 minutes. No complications relating to ostial artery catheter-induced dissections were encountered.
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Affiliation(s)
- Brian Hynes
- Vascular Medicine and Intervention, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Cademartiri F, Runza G, Palumbo A, Maffei E, Martini C, McFadden E, Somers P, Knaapen M, Verheye S, Weustink AC, Mollet NR, de Feyter PJ, Hamers R, Bruining N. Lumen enhancement influences absolute noncalcific plaque density on multislice computed tomography coronary angiography: ex-vivo validation and in-vivo demonstration. J Cardiovasc Med (Hagerstown) 2010; 11:337-44. [PMID: 20090551 DOI: 10.2459/jcm.0b013e3283312400] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM The purpose of this study was to define the in-vitro and in-vivo effects of intracoronary enhancement on the absolute density values of coronary plaques during multislice computed tomography. METHODS We studied seven ex-vivo left coronary artery specimens surrounded by olive oil and filled with isotonic saline and four solutions with decreasing dilutions of contrast material: control (isotonic saline), 1/200, 1/80, 1/50, and 1/20. The multislice computed tomography protocol was: slice/collimation 32 x 2 x 0.6 mm and rotation time 330 ms. The attenuation (Hounsfield units) value of atherosclerotic plaques was measured for each dilution in lumen, plaque (noncalcified coronary wall thickening), calcium, and surrounding oil. In-vivo assessment was performed in 12 patients (nine men; mean age 58.7 +/- 9.9 years) who underwent two subsequent multislice computed tomography scans (arterial and delayed) after intravenous administration of a single bolus of contrast material. The attenuation values of lumen and plaques during arterial and delayed computed tomography were compared. The results were compared with one-way analysis of variance and correlated with Pearson's test. RESULTS Mean lumen (45 +/- 38-669 +/- 151 HU) and plaque (11 +/- 35-101 +/- 72 HU) attenuation differed significantly (P < 0.001) among the different dilutions. The attenuation of lumen and plaque of coronary plaques showed moderate correlation (r = 0.54, P < 0.001). The mean attenuation value in vivo for the arterial and delayed phase scans differed significantly (P < 0.001) for lumen (325 +/- 70 and 174 +/- 46 HU, respectively) and plaque (138 +/- 71 and 100 +/- 52 HU, respectively). CONCLUSION Coronary plaque attenuation values are significantly modified by differences in lumen contrast densities both ex vivo and in vivo. This should be taken into account when considering the distinction between lipid and fibrous plaques.
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Affiliation(s)
- Filippo Cademartiri
- Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Kedhi E, Joesoef KS, McFadden E, Wassing J, van Mieghem C, Goedhart D, Smits PC. Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE): a randomised trial. Lancet 2010; 375:201-9. [PMID: 20060578 DOI: 10.1016/s0140-6736(09)62127-9] [Citation(s) in RCA: 561] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Everolimus-eluting and paclitaxel-eluting stents, compared with bare metal stents, reduced the risk of restenosis in clinical trials with strict inclusion and exclusion criteria. We compared the safety and efficacy of the second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice. METHODS We randomly assigned 1800 consecutive patients (aged 18-85 years) undergoing percutaneous coronary intervention at one centre to treatment with everolimus-eluting or paclitaxel-eluting stents. The primary endpoint was a composite of safety and efficacy (all-cause mortality, myocardial infarction, and target vessel revascularisation) within 12 months. Patients were not told which stent they had been allocated. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT01016041. FINDINGS Follow-up was completed in 1797 patients. The primary endpoint occurred in 56 (6%) of 897 patients in the everolimus-eluting stent group versus 82 (9%) of 903 in the paclitaxel-eluting stent group (relative risk 0.69 [95% CI 0.50-0.95], p value for superiority=0.02). The difference was attributable to a lower rate of stent thrombosis (6 [<1%] vs 23 [3%], 0.26 [0.11-0-64], p=0.002), myocardial infarction (25 [3%] vs 48 [5%], 0.52 [0.33-0.84], p=0.007), and target vessel revascularisation (21 [2%] vs 54 [6%], 0.39 [0.24-0.64], p=0.0001). Cardiac death, non-fatal myocardial infarction, or target lesion revascularisation occurred in 44 [5%] patients in the everolimus-eluting stent group versus 74 [8%] patients in the paclitaxel-eluting stent group, p value for superiority was 0.005. INTERPRETATION The everolimus-eluting stent is better than the second generation paclitaxel-eluting stent in unselected patients in terms of safety and efficacy. On the basis of our results, we suggest that paclitaxel-eluting stents should no longer be used in everyday clinical practice. FUNDING Unrestricted grants from Abbott Vascular and Boston Scientific.
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Affiliation(s)
- Elvin Kedhi
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, Netherlands
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Rodriguez-Granillo G, Valgimigli M, Ong ATL, Aoki J, van Mieghem CAG, Hoye A, Tsuchida K, McFadden E, de Feyter P, Serruys PW. Paclitaxel eluting stents for the treatment of angiographically non‐significant atherosclerotic lesions. ACTA ACUST UNITED AC 2009; 7:68-71. [PMID: 16093214 DOI: 10.1080/14628840510011261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of the implantation of Paclitaxel Eluting Stents (PES) for de novo, non-flow limiting lesions. METHODS AND RESULTS We assessed the 12-month occurrence of major adverse cardiac events (MACE) in 21 patients (4% of the total population treated in a 'real world' registry) with 22 non-significant coronary narrowings treated with PES. The following criteria had to be met: (1) the lesion was de novo; (2) the location was non-ostial, and not a bifurcation lesion; (3) the diameter stenosis by quantitative coronary angiography (QCA) was <50%; (4) there was no visible thrombus and (5) the lesion was not located in an angiographically diffusely diseased segment. Procedural success rate was 100% without any periprocedural myocardial infarction. After a mean follow-up of 407.33+/-53 (range: 344-498) days the overall MACE-free survival was 95.2%. Freedom from target revascularization was 95.2%. CONCLUSIONS The result of this non-randomized observational study suggests that the implantation of PES for de novo, non-significant lesions appears most probably safe and effective.
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O'Sullivan JF, McFadden E. Ostial left main coronary stenosis in a frequent flyer. Int J Cardiol 2009; 134:e66-7. [PMID: 18378023 DOI: 10.1016/j.ijcard.2007.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 12/26/2007] [Indexed: 11/15/2022]
Abstract
A 52 year old gentleman presented with chest pain, after a long distance flight from India; he had made long haul flights every 2 weeks over the last 5 years as part of his job. His ECG revealed T wave inversion in leads V1-3. Cardiac biomarkers including troponin were negative; we proceeded to exercise stress testing (EST). This revealed 2 mm ST depression at 2 min of the standard Bruce protocol, associated with chest pain. He was taken immediately to the coronary catheterization laboratory; engagement of the left main caused pressure damping with 6 French, then 5 French diagnostic Judkins left 4 catheters. An ostial left main stenosis was seen; the right and left coronary trees otherwise had no significant stenoses. He had normal LV function. He underwent inpatient CABG 7 days later.
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McFadden E, Luben R, Bingham S, Wareham N, Kinmonth AL, Khaw KT. Self-rated health does not explain the socioeconomic differential in mortality: a prospective study in the EPIC-Norfolk cohort. J Epidemiol Community Health 2009; 63:329-31. [PMID: 19147634 DOI: 10.1136/jech.2008.078139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Self-rated health (SRH), a subjective measure of health, is strongly predictive of mortality, independently of objective measures of health status and existing known disease. There is a strong social gradient in SRH. An investigation was carried to determine whether SRH can explain the well-known socioeconomic gradient in mortality. METHODS The effect of adjusting for SRH on the socioeconomic differential in mortality was examined in a prospective study of 20 754 men and women aged 39-79 years, without prevalent disease, living in the general community in Norfolk, UK, recruited using general practice age-sex registers for 1993-1997 and followed up for an average of 10 years. RESULTS Mortality risk increased with decreasing social class in men and women. There was some attenuation after adjustment for covariates age, body mass index, smoking, history of diabetes, systolic blood pressure, cholesterol level, alcohol consumption, physical activity and educational level, but a gradient remained. Further adjustment for SRH attenuated the association slightly more, but there was still some evidence of a socioeconomic differential in mortality, particularly in class V compared with class I (age- and sex-adjusted hazard ratio 1.57; 95% CI 1.19 to 2.06). CONCLUSIONS SRH does not substantially explain the socioeconomic differential in mortality beyond that explained by health-related covariates.
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Affiliation(s)
- E McFadden
- Institute of Public Health,University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, UK.
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McFadden E, Luben R, Bingham S, Wareham N, Kinmonth AL, Khaw KT. Does the association between self-rated health and mortality vary by social class? Soc Sci Med 2009; 68:275-80. [DOI: 10.1016/j.socscimed.2008.10.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Indexed: 11/26/2022]
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Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115:2344-51. [PMID: 17470709 DOI: 10.1161/circulationaha.106.685313] [Citation(s) in RCA: 4496] [Impact Index Per Article: 264.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although most clinical trials of coronary stents have measured nominally identical safety and effectiveness end points, differences in definitions and timing of assessment have created confusion in interpretation. METHODS AND RESULTS The Academic Research Consortium is an informal collaboration between academic research organizations in the United States and Europe. Two meetings, in Washington, DC, in January 2006 and in Dublin, Ireland, in June 2006, sponsored by the Academic Research Consortium and including representatives of the US Food and Drug Administration and all device manufacturers who were working with the Food and Drug Administration on drug-eluting stent clinical trial programs, were focused on consensus end point definitions for drug-eluting stent evaluations. The effort was pursued with the objective to establish consistency among end point definitions and provide consensus recommendations. On the basis of considerations from historical legacy to key pathophysiological mechanisms and relevance to clinical interpretability, criteria for assessment of death, myocardial infarction, repeat revascularization, and stent thrombosis were developed. The broadly based consensus end point definitions in this document may be usefully applied or recognized for regulatory and clinical trial purposes. CONCLUSION Although consensus criteria will inevitably include certain arbitrary features, consensus criteria for clinical end points provide consistency across studies that can facilitate the evaluation of safety and effectiveness of these devices.
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Affiliation(s)
- Donald E Cutlip
- Harvard Clinical Research Institute, Harvard Medical School, 930 Commonwealth Avenue, Boston, MA 02215, USA.
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Valgimigli M, Steendijk P, Serruys PW, Vranckx P, Boomsma F, Onderwater E, Vaina S, Ligthart JM, McFadden E, van der Ent M, de Jaegere P, Sianos G. Use of Impella Recover(R) LP 2.5 left ventricular assist device during high-risk percutaneous coronary interventions; clinical, haemodynamic and biochemical findings. EUROINTERVENTION 2006; 2:91-100. [PMID: 19755242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To investigate in terms of clinical, haemodynamic and biochemical profile the safety and efficacy of the Impella Recover(R) LP 2.5 left ventricular assist device during elective high risk percutaneous coronary interventions (HR-PCI). METHODS AND RESULTS Ten out of twelve patients were initially enrolled to receive PCI supported by the Impella catheter; eight underwent pressure-volume (PV) loop analysis while one patient was monitored by intra-cardiac echocardiographic. Free haemoglobin (fHb), B-type natriuretic pepetide, catecholamines, aldosterone, angiotensin II, and endothelin were assessed before, every 40 minutes as average during the procedure and at 3, 12, 24 and 48 hours after intervention. The Impella catheter was used for 144+/-88 min [median (IQR) 108 (85-198)], and was removed immediately after the procedure in all but one patients. In 6, 3 and 2 patients, fHb levels increased above 1, 5 and 10 times the upper limit of normal (ULN), respectively. No significant effect was found on the tested biomarkers in Impella-supported procedures. The PV analysis showed the occurrence of an acute volume increase in the majority of patients immediately after Impella insertion that tended to persist even at maximal pump speed. This was confirmed by the intracardiac echocardiography that was performed in one patient. CONCLUSIONS Our data, although preliminary due to the limited sample size, does not encourage the routine use of Impella Recover(R) LP 2.5 in HR-PCI. Additional studies are required to confirm and elucidate the mechanisms responsible for the acute LV volume loading and to quantify the degree of haemolysis induced by the pump in a broader set of patients.
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Affiliation(s)
- Marco Valgimigli
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Rodriguez-Granillo GA, Aoki J, Ong ATL, Valgimigli M, Van Mieghem CAG, Regar E, McFadden E, De Feyter P, Serruys PW. Methodological considerations and approach to cross-technique comparisons using in vivo coronary plaque characterization based on intravascular ultrasound radiofrequency data analysis: insights from the Integrated Biomarker and Imaging Study (IBIS). ACTA ACUST UNITED AC 2005; 7:52-8. [PMID: 16025628 DOI: 10.1080/14628840410030559] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Grey scale intravascular ultrasound (IVUS) is a valuable clinical tool to assess the extent and severity of coronary atheroma. However, it cannot reliably identify plaques with a high-risk of future clinical events. Serial IVUS studies to assess the progression and/or regression of atherosclerotic plaques demonstrated only modest effects, of pharmacological intervention on plaque burden, even when clinical efficacy is documented. Spectral analysis of radiofrequency ultrasound data (IVUS-virtual histology (IVUS-VH), Volcano Therapeutics, Rancho Cordova, CA) has the potential to characterize accurately plaque composition. The Integrated Biomarker and Imaging Study (IBIS) evaluated both invasive and non-invasive imaging techniques along with the assessment of novel biomarkers to characterize sub-clinical atherosclerosis. IVUS-VH was not included at the start of the IBIS protocol. The purpose of this paper is to describe the methodology we used to obtain and analyse IVUS-VH images and the approach to cross-correlations with the other techniques.
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Rodriguez-Granillo GA, Valgimigli M, Garcia-Garcia HM, Ong ATL, Aoki J, van Mieghem CAG, Tsuchida K, Sianos G, McFadden E, van der Giessen WJ, van Domburg R, de Feyter P, Serruys PW. One-year clinical outcome after coronary stenting of very small vessels using 2.25 mm sirolimus- and paclitaxel-eluting stents: a comparison between the RESEARCH and T-SEARCH registries. J Invasive Cardiol 2005; 17:409-12. [PMID: 16079445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND The efficacy of sirolimus-eluting stents (SES) compared to paclitaxel-eluting stents (PES) remains unknown. We evaluated the clinical outcomes after implantation of 2.25 mm diameter SES and PES. METHODS AND RESULTS PES have been used as the stent of choice for all percutaneous coronary interventions as part of the prospective Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) Registry. Ninety consecutive patients received at least one 2.25 mm PES (PES group), and were compared with 107 patients who received at least one 2.25 mm SES as part of the RESEARCH registry. The overall population presented high-risk characteristics commonly excluded from most studies. Populations were well-matched. There were 2 (2.2%) incidents of subacute stent thrombosis in the PES group (in a 2.25 mm stent), and none in the SES group. At one year, the cumulative incidence of major adverse cardiac events was 5.6% in the SES group, and 17.8% in the PES group (p = 0.007). After adjustments for other significant univariate variables, presentation with acute coronary syndrome (ACS) (adjusted OR 5.2 [95% CI 1.8-15.0], p = 0.002) and PES utilization (adjusted OR 3.7 [95% CI 1.3-10.5], p = 0.013) were found to be significant independent predictors of major adverse cardiac events (MACE). CONCLUSIONS In an unselected population treated for very small vessel disease, SES were associated with better 12-month clinical outcomes and the use of PES was identified as an independent predictor of adverse events.
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Affiliation(s)
- Gastón A Rodriguez-Granillo
- Cardiac Catheterization Laboratory, Thoraxcenter, Erasmus Medical Center, Rotterdam, Kamer Z-120, Dr. Molewaterplein 40, Rotterdam, The Netherlands 3015 GD.
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van der Giessen WJ, Regar E, McFadden E, McDougall I, Serruys PW. Assessment of stent dimensions with a novel intracoronary balloon-based system: comparative study versus intravascular ultrasound and quantitative coronary angiography. The CAMUS - Coronary Angioplasty Metricath vs. UltraSound Trial. EUROINTERVENTION 2005; 1:244-251. [PMID: 19758910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To compare measurements of coronary stent dimensions using a novel, low pressure balloon catheter-based technique - Metricath (MC), with those obtained by intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). BACKGROUND Intravascular ultrasound (IVUS), the current gold standard to optimize stent placement is expensive, not widely available, and needs expertise for interpretation. METHODS AND RESULTS We compared cross-sectional diameter and area measurements obtained by MC, IVUS, and QCA immediately after successful stent implantation. The order of measurements was randomized. Both on-line and off-line (independent core lab) analysis was performed.Measurements were obtained in 21 patients at 22 stents in the LAD (n=10), RCA (n=6), and LCx (n=6). Nominal stent diameter was 2.5-3.5 mm. Average stent diameter was 2.54+/-0.28 mm by QCA, 2.77+/-0.31 mm by IVUS, and 2.86+/-0.28 mm by MC (P<0.001 QCA versus MC, P=0.13 IVUS versus MC). Results of on-line area measurements showed a small but significant difference between IVUS and MC 0.53 mm2, 95% confidence interval 0.17-0.90 mm2, P<0.01. Regression analysis demonstrated, however, that MC correlated best with off-line IVUS (diameter: y=1.01x, R2=0.83, P<0.001; area: y=1.02x, R2=0.81, P<0.001). Bland-Altman analysis showed a mean difference in diameter between on-line MC and off-line IVUS of 0.03+/-0.12 mm and between MC and off-line QCA of 0.10+/-0.23 mm. CONCLUSION MC is a new, promising method providing information on average stent dimensions that is equivalent to that obtained by off-line IVUS analyzed in an independent core lab.
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Hoye A, Ong ATL, Aoki J, van Mieghem CAG, Rodriguez Granillo GA, Valgimigli M, Sianos G, McFadden E, van der Giessen WJ, de Feyter PJ, van Domburg RT, Serruys PW. Drug-eluting stent implantation for chronic total occlusions: comparison between the Sirolimus- and Paclitaxel-eluting stent. EUROINTERVENTION 2005; 1:193-197. [PMID: 19758902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS Long-term results following percutaneous coronary intervention (PCI) with bare metal stents in the treatment of chronic total occlusions (CTOs) is hindered by a significant rate of restenosis and re-occlusion. Drug-eluting stents have shown dramatically reduced restenosis rates for the treatment of relatively simple non-occlusive lesions, though there is only limited data as to the efficacy in CTO's. We evaluated the long-term results of the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) for the treatment of CTOs. METHODS AND RESULTS From April 2002, all patients at our institution were treated with SES as the device of choice during PCI. During the first quarter of 2003 the default strategy changed to the use of PES. Drug-eluting stent implantation was carried out in CTOs (defined as >3 months' duration) in 9% of de novo PCI procedures. A total of 76 consecutive patients were treated with SES implantation, followed by a consecutive series of 57 patients treated with PES implantation. These patients were compared with a similar group of patients (n=26) treated with BMS in the 6-month period preceding April 2002. At 400 days, the cumulative survival-free of target vessel revascularization was 80.8% in the BMS group versus 97.4% and 96.4% in the SES and PES groups respectively (p=0.01). CONCLUSIONS The use of both the SES and PES in the treatment of chronic total coronary occlusions reduces the need for target vessel revascularization compared to bare metal stents.
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Affiliation(s)
- Angela Hoye
- Department of Interventional Cardiology, Erasmus MC, Rotterdam, The Netherlands
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Van Mieghem CAG, Bruining N, Schaar JA, McFadden E, Mollet N, Cademartiri F, Mastik F, Ligthart JMR, Granillo GAR, Valgimigli M, Sianos G, van der Giessen WJ, Backx B, Morel MAM, Van Es GA, Sawyer JD, Kaplow J, Zalewski A, van der Steen AFW, de Feyter P, Serruys PW. Rationale and methods of the integrated biomarker and imaging study (IBIS): combining invasive and non-invasive imaging with biomarkers to detect subclinical atherosclerosis and assess coronary lesion biology. Int J Cardiovasc Imaging 2005; 21:425-41. [PMID: 16047125 DOI: 10.1007/s10554-004-7986-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 07/06/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
Abstract
Death or myocardial infarction, the most serious clinical consequences of atherosclerosis, often result from plaque rupture at non-flow limiting lesions. Current diagnostic imaging with coronary angiography only detects large plaques that already impinge on the lumen and cannot accurately identify those that have a propensity to cause unheralded events. Accurate evaluation of the composition or of the biomechanical characteristics of plaques with invasive or non-invasive methods, alone or in conjunction with assessment of circulating biomarkers, could help identify high-risk patients, thus providing the rationale for aggressive treatments in order to reduce future clinical events. The IBIS (Integrated Biomarker and Imaging Study) study is a prospective, single-center, non-randomized, observational study conducted in Rotterdam. The aim of the IBIS study is to evaluate both invasive (quantitative coronary angiography, intravascular ultrasound (IVUS) and palpography) and non-invasive (multislice spiral computed tomography) imaging techniques to characterize non-flow limiting coronary lesions. In addition, multiple classical and novel biomarkers will be measured and their levels correlated with the results of the different imaging techniques. A minimum of 85 patients up to a maximum of 120 patients will be included. This paper describes the study protocol and methodological solutions that have been devised for the purpose of comparisons among several imaging modalities. It outlines the analyses that will be performed to compare invasive and non-invasive imaging techniques in conjunction with multiple biomarkers to characterize non-flow limiting subclinical coronary lesions.
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Aoki J, Ong A, Rodriguez-Granillo G, VanMieghem C, Daemen J, Sonnenschein K, McFadden E, Sianos G, van der Giessen W, de Feyter P, van Domburg R, Serruys P. The efficacy of sirolimus-eluting stents versus bare metal stents for diabetic patients undergoing elective percutaneous coronary intervention. J Invasive Cardiol 2005; 17:344-8. [PMID: 16003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Diabetes mellitus is a well-known risk factor for future adverse cardiac events after coronary intervention with conventional metal stents. In this study, the impact of sirolimus-eluting stents (SES) were evaluated in a consecutive group of diabetic patients undergoing elective percutaneous coronary treatment and compared to a population treated with bare metal stents. METHODS AND RESULTS From April 2002, a policy of routine SES implantation has been instituted in our hospital. During 1 year of enrollment, a total of 112 consecutive diabetic patients with de novo coronary lesions were electively treated with SES (SES group). A similar group for comparison comprised 118 consecutive patients treated with bare metal stents in the preceding period (the pre-SES group). After 1-year follow-up, the cumulative rate of major adverse cardiac events (death, myocardial infarction, and any repeat revascularization) was 17.3% in the SES group versus 30.2% in the pre-SES group (hazard ratio, 0.54 [95% confidence interval, 0.32-0.91]; p = 0.02), mainly due to a marked reduction in the need for repeat revascularization (10.2% versus 23.5%; hazard ratio, 0.40 [95% confidence interval, 0.21-0.78]; p = 0.007). CONCLUSIONS Routine utilization of SES for diabetic patients significantly reduces the rate of adverse cardiac events at 1 year compared to bare metal stents.
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Affiliation(s)
- Jiro Aoki
- Interventional Cardiology, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
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Rodriguez-Granillo GA, Serruys PW, Garcia-Garcia HM, Aoki J, Valgimigli M, van Mieghem CAG, McFadden E, de Jaegere PPT, de Feyter P. Coronary artery remodelling is related to plaque composition. Heart 2005; 92:388-91. [PMID: 15964942 PMCID: PMC1860793 DOI: 10.1136/hrt.2004.057810] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the potential relation between plaque composition and vascular remodelling by using spectral analysis of intravascular ultrasound (IVUS) radiofrequency data. METHODS AND RESULTS 41 coronary vessels with non-significant (< 50% diameter stenosis by angiography), < or = 20 mm, non-ostial lesions located in non-culprit vessels underwent IVUS interrogation. IVUS radiofrequency data obtained with a 30 MHz catheter, were analysed with IVUS virtual histology software. A remodelling index (RI) was calculated and divided into three groups. Lesions with RI > or = 1.05 were considered to have positive remodelling and lesions with RI < or = 0.95 were considered to have negative remodelling. Lesions with RI > or = 1.05 had a significantly larger lipid core than lesions with RI 0.96-1.04 and RI < or = 0.95 (22.1 (6.3) v 15.1 (7.6) v 6.6 (6.9), p < 0.0001). A positive correlation between lipid core and RI (r = 0.83, p < 0.0001) and an inverse correlation between fibrous tissue and RI (r = -0.45, p = 0.003) were also significant. All of the positively remodelled lesions were thin cap fibroatheroma or fibroatheromatous lesions, whereas negatively remodelled lesions had a more stable phenotype, with 64% having pathological intimal thickening, 29% being fibrocalcific lesions, and only 7% fibroatheromatous lesions (p < 0.0001). CONCLUSIONS In this study, in vivo plaque composition and morphology assessed by spectral analysis of IVUS radiofrequency data were related to coronary artery remodelling.
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