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Weber T, Wassertheurer S, Mayer CC, Hametner B, Danninger K, Townsend RR, Mahfoud F, Kario K, Fahy M, DeBruin V, Peterson N, Negoita M, Weber MA, Kandzari DE, Schmieder RE, Tsioufis KP, Binder RK, Böhm M. Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial. Hypertension 2022; 79:1506-1514. [PMID: 35582957 PMCID: PMC9172874 DOI: 10.1161/hypertensionaha.121.18641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | | | - Christopher C Mayer
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Bernhard Hametner
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Martin Fahy
- Medtronic PLC, Santa Rosa, CA (M.F., V.D., N.P., M.N.)
| | | | | | | | | | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Germany (R.E.S.)
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.P.T.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
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Nikolsky E, Mehran R, Mintz GS, Dangas GD, Lansky AJ, Aymong ED, Negoita M, Fahy M, Moussa I, Roubin GS, Moses JW, Stone GW, Leon MB. Impact of Symptomatic Peripheral Arterial Disease on 1-Year Mortality in Patients Undergoing Percutaneous Coronary Interventions. J Endovasc Ther 2016; 11:60-70. [PMID: 14748627 DOI: 10.1177/152660280401100108] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the impact of symptomatic peripheral arterial disease (PAD) on clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Methods and Results: Symptomatic PAD was identified in 1969 (18.9%) of 10440 consecutive patients undergoing PCI. Patients with PAD were older, more frequently female, and had smaller body surface area and more atherosclerotic risk factors, chronic renal insufficiency, and heart failure. Patients with PAD had lower rates of procedural success (94.2% versus 96.2%, p<0.0001) and higher rates of in-hospital complications, including all-cause mortality (2.1% versus 1.1%, p=0.0002), cardiac death (1.5% versus 0.7%, p=0.0009), urgent coronary artery bypass grafting (1.9% versus 1.2%, p=0.01), recurrent ischemia (5.6% versus 2.8%, p<0.0001), re-PCI to the target lesion (2.4% versus 1.1%, p<0.0001), stroke (0.6% versus 0.3%, p=0.0344), transient ischemic attack (0.4% versus 0.1%, p=0.01), femoral hematoma (10.3% versus 8.5%, p=0.01), retroperitoneal hematoma (0.8% versus 0.3%, p=0.009), limb ischemia (3.0% versus 0.7%, p<0.0001), gastrointestinal bleeding (1.9% versus 0.9%, p<0.0001), and blood transfusion (10.1% versus 5.2%, p<0.0001). At 1-year follow-up, patients with PAD had a higher mortality rate (13.6% versus 5.2%, p<0.0001), a higher rate of myocardial infarction (8.3% versus 6.5%, p=0.008), and also more target lesion (21.2% versus 19.8%, p=0.02) or target vessel revascularization (24.6% versus 21.2%, p=0.002). By multivariate analysis, PAD was an independent predictor of 1-year mortality (odds ratio 1.71, 95% confidence interval 1.42 to 2.07, p<0.0001). Conclusions: Nearly a fifth of patients undergoing PCI have symptomatic PAD. The presence of PAD is associated with lower rates of procedural success, higher rates of in-hospital and 1-year adverse events, and is independently associated with increased 1-year mortality.
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Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation and the Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA
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Iqbal J, Serruys PW, Silber S, Kelbaek H, Richardt G, Morel MA, Negoita M, Buszman PE, Windecker S. Comparison of zotarolimus- and everolimus-eluting coronary stents: final 5-year report of the RESOLUTE all-comers trial. Circ Cardiovasc Interv 2016; 8:e002230. [PMID: 26047993 PMCID: PMC4495878 DOI: 10.1161/circinterventions.114.002230] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background— Newer-generation drug-eluting stents that release zotarolimus or everolimus
have been shown to be superior to the first-generation drug-eluting stents.
However, data comparing long-term safety and efficacy of zotarolimus- (ZES)
and everolimus-eluting stents (EES) are limited. RESOLUTE all-comers
(Randomized Comparison of a Zotarolimus-Eluting Stent With an
Everolimus-Eluting Stent for Percutaneous Coronary Intervention) trial
compared these 2 stents and has shown that ZES was noninferior to EES at
12-month for the primary end point of target lesion failure. We report the
secondary clinical outcomes at the final 5-year follow-up of this trial. Methods and Results— RESOLUTE all-comer clinical study is a prospective, multicentre, randomized,
2-arm, open-label, noninferiority trial with minimal exclusion criteria.
Patients (n=2292) were randomly assigned to treatment with either ZES
(n=1140) or EES (n=1152). Patient-oriented composite end point (combination
of all-cause mortality, myocardial infarction, and any revascularizations),
device-oriented composite end point (combination of cardiac death, target
vessel myocardial infarction, and clinically indicated target lesion
revascularization), and major adverse cardiac events (combination of
all-cause death, all myocardial infarction, emergent coronary bypass
surgery, or clinically indicated target lesion revascularization) were
analyzed at 5-year follow-up. The 2 groups were well-matched at baseline.
Five-year follow-up data were available for 98% patients. There were no
differences in patient-oriented composite end point (ZES 35.3% versus EES
32.0%, P=0.11), device-oriented composite end point (ZES
17.0% versus EES 16.2%, P=0.61), major adverse cardiac
events (ZES 21.9% versus EES 21.6%, P=0.88), and
definite/probable stent thrombosis (ZES 2.8% versus EES 1.8%,
P=0.12). Conclusions— At 5-year follow-up, ZES and EES had similar efficacy and safety in a
population of patients who had minimal exclusion criteria. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00617084.
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Affiliation(s)
- Javaid Iqbal
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Patrick W Serruys
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.).
| | - Sigmund Silber
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Henning Kelbaek
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Gert Richardt
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Marie-Angele Morel
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Manuela Negoita
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Pawel E Buszman
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Stephan Windecker
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
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Kario K, Ogawa H, Okumura K, Okura T, Saito S, Ueno T, Haskin R, Negoita M, Shimada K. SYMPLICITY HTN-Japan - First Randomized Controlled Trial of Catheter-Based Renal Denervation in Asian Patients - . Circ J 2015; 79:1222-9. [PMID: 25912693 DOI: 10.1253/circj.cj-15-0150] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND SYMPLICITY HTN-Japan is a prospective, randomized, controlled trial comparing renal artery denervation (RDN) with standard pharmacotherapy for treatment of resistant hypertension (systolic blood pressure [SBP] ≥160 mmHg on ≥3 anti-hypertensive drugs including a diuretic for ≥6 weeks). When SYMPLICITY HTN-3 failed to meet the primary efficacy endpoint, the HTN-Japan enrollment was discontinued before completion. METHODS AND RESULTS: The 6-month change in office and 24-h ambulatory SBP were compared between RDN (n=22) and control (n=19) subjects. Mean baseline office SBP was 181.0±18.0 mmHg and 178.7±17.8 mmHg for the RDN and control groups, respectively. The 6-month office SBP change was -16.6±18.5 mmHg for RDN subjects (P<0.001) and -7.9±21.0 mmHg for control subjects (P=0.117); the difference between the 6-month change in RDN and control subjects was -8.64 (95% CI: -21.12 to 3.84, P=0.169). Mean 24-h SBP was 164.7±18.3 (RDN group) and 163.3±17.2 mmHg (control group). The 24-h 6-month SBP change for the RDN group was -7.52±11.98 mmHg (P=0.008) and -1.38±10.2 mmHg (P=0.563) for control subjects; the between-group difference in SBP change was -6.15 (95% CI: -13.23 to 0.94, P=0.087). No major adverse events were reported. CONCLUSIONS SYMPLICITY HTN-Japan, the first randomized controlled trial of RDN in an Asian population, was underpowered for the primary endpoint analysis and did not demonstrate a significant difference in 6-month BP change between RDN and control subjects.
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Affiliation(s)
- Kazuomi Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine
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Böhm M, Mahfoud F, Ukena C, Hoppe UC, Narkiewicz K, Negoita M, Ruilope L, Schlaich MP, Schmieder RE, Whitbourn R, Williams B, Zeymer U, Zirlik A, Mancia G. First report of the Global SYMPLICITY Registry on the effect of renal artery denervation in patients with uncontrolled hypertension. Hypertension 2015; 65:766-74. [PMID: 25691618 DOI: 10.1161/hypertensionaha.114.05010] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED This study aimed to assess the safety and effectiveness of renal denervation using the Symplicity system in real-world patients with uncontrolled hypertension (NCT01534299). The Global SYMPLICITY Registry is a prospective, open-label, multicenter registry. Office and 24-hour ambulatory blood pressures (BPs) were measured. Change from baseline to 6 months was analyzed for all patients and for subgroups based on baseline office systolic BP, diabetic status, and renal function; a cohort with severe hypertension (office systolic pressure, ≥160 mm Hg; 24-hour systolic pressure, ≥135 mm Hg; and ≥3 antihypertensive medication classes) was also included. The analysis included protocol-defined safety events. Six-month outcomes for 998 patients, including 323 in the severe hypertension cohort, are reported. Mean baseline office systolic BP was 163.5±24.0 mm Hg for all patients and 179.3±16.5 mm Hg for the severe cohort; the corresponding baseline 24-hour mean systolic BPs were 151.5±17.0 and 159.0±15.6 mm Hg. At 6 months, the changes in office and 24-hour systolic BPs were -11.6±25.3 and -6.6±18.0 mm Hg for all patients (P<0.001 for both) and -20.3±22.8 and -8.9±16.9 mm Hg for those with severe hypertension (P<0.001 for both). Renal denervation was associated with low rates of adverse events. After the procedure through 6 months, there was 1 new renal artery stenosis >70% and 5 cases of hospitalization for a hypertensive emergency. In clinical practice, renal denervation resulted in significant reductions in office and 24-hour BPs with a favorable safety profile. Greater BP-lowering effects occurred in patients with higher baseline pressures. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT01534299.
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Affiliation(s)
- Michael Böhm
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.).
| | - Felix Mahfoud
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Christian Ukena
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uta C Hoppe
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Krzysztof Narkiewicz
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Manuela Negoita
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Luis Ruilope
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Markus P Schlaich
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Roland E Schmieder
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Robert Whitbourn
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Bryan Williams
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uwe Zeymer
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Andreas Zirlik
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Giuseppe Mancia
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
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Bakris GL, Townsend RR, Liu M, Cohen SA, D'Agostino R, Flack JM, Kandzari DE, Katzen BT, Leon MB, Mauri L, Negoita M, O'Neill WW, Oparil S, Rocha-Singh K, Bhatt DL. Impact of renal denervation on 24-hour ambulatory blood pressure: results from SYMPLICITY HTN-3. J Am Coll Cardiol 2014; 64:1071-8. [PMID: 24858423 DOI: 10.1016/j.jacc.2014.05.012] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prior studies of catheter-based renal artery denervation have not systematically performed ambulatory blood pressure monitoring (ABPM) to assess the efficacy of the procedure. OBJECTIVES SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) was a prospective, blinded, randomized, sham-controlled trial. The current analysis details the effect of renal denervation or a sham procedure on ABPM measurements 6 months post-randomization. METHODS Patients with resistant hypertension were randomized 2:1 to renal denervation or sham control. Patients were on a stable antihypertensive regimen including maximally tolerated doses of at least 3 drugs including a diuretic before randomization. The powered secondary efficacy endpoint was a change in mean 24-h ambulatory systolic blood pressure (SBP). Nondipper to dipper (nighttime blood pressure [BP] 10% to 20% lower than daytime BP) conversion was calculated at 6 months. RESULTS The 24-h ambulatory SBP changed -6.8 ± 15.1 mm Hg in the denervation group and -4.8 ± 17.3 mm Hg in the sham group: difference of -2.0 mm Hg (95% confidence interval [CI]: -5.0 to 1.1; p = 0.98 with a 2 mm Hg superiority margin). The daytime ambulatory SBP change difference between groups was -1.1 (95% CI: -4.3 to 2.2; p = 0.52). The nocturnal ambulatory SBP change difference between groups was -3.3 (95 CI: -6.7 to 0.1; p = 0.06). The percent of nondippers converted to dippers was 21.2% in the denervation group and 15.0% in the sham group (95% CI: -3.8% to 16.2%; p = 0.30). Change in 24-h heart rate was -1.4 ± 7.4 in the denervation group and -1.3 ± 7.3 in the sham group; (95% CI: -1.5 to 1.4; p = 0.94). CONCLUSIONS This trial did not demonstrate a benefit of renal artery denervation on reduction in ambulatory BP in either the 24-h or day and night periods compared with sham (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]; NCT01418261).
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Affiliation(s)
- George L Bakris
- ASH Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois.
| | - Raymond R Townsend
- School of Medicine, Renal Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Minglei Liu
- Medtronic CardioVascular, Santa Rosa, California
| | - Sidney A Cohen
- School of Medicine, Renal Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Medtronic CardioVascular, Santa Rosa, California
| | - Ralph D'Agostino
- Department of Medicine, Division of Cardiology, Harvard Clinical Research Institute and Boston University School of Public Health, Boston, Massachusetts
| | - John M Flack
- Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, Michigan
| | - David E Kandzari
- Department of Medicine, Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Barry T Katzen
- Department of Medicine, Division of Cardiology, Baptist Cardiac and Vascular Institute, Miami, Florida
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, and Cardiovascular Research Foundation, New York, New York
| | - Laura Mauri
- Department of Medicine, Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, Massachusetts
| | | | - William W O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Suzanne Oparil
- Department of Medicine, Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Krishna Rocha-Singh
- Department of Medicine, Division of Cardiology, Prairie Heart Institute, Springfield, Illinois
| | - Deepak L Bhatt
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
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Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370:1393-401. [PMID: 24678939 DOI: 10.1056/nejmoa1402670] [Citation(s) in RCA: 1493] [Impact Index Per Article: 149.3] [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: 12/18/2022]
Abstract
BACKGROUND Prior unblinded studies have suggested that catheter-based renal-artery denervation reduces blood pressure in patients with resistant hypertension. METHODS We designed a prospective, single-blind, randomized, sham-controlled trial. Patients with severe resistant hypertension were randomly assigned in a 2:1 ratio to undergo renal denervation or a sham procedure. Before randomization, patients were receiving a stable antihypertensive regimen involving maximally tolerated doses of at least three drugs, including a diuretic. The primary efficacy end point was the change in office systolic blood pressure at 6 months; a secondary efficacy end point was the change in mean 24-hour ambulatory systolic blood pressure. The primary safety end point was a composite of death, end-stage renal disease, embolic events resulting in end-organ damage, renovascular complications, or hypertensive crisis at 1 month or new renal-artery stenosis of more than 70% at 6 months. RESULTS A total of 535 patients underwent randomization. The mean (±SD) change in systolic blood pressure at 6 months was -14.13±23.93 mm Hg in the denervation group as compared with -11.74±25.94 mm Hg in the sham-procedure group (P<0.001 for both comparisons of the change from baseline), for a difference of -2.39 mm Hg (95% confidence interval [CI], -6.89 to 2.12; P=0.26 for superiority with a margin of 5 mm Hg). The change in 24-hour ambulatory systolic blood pressure was -6.75±15.11 mm Hg in the denervation group and -4.79±17.25 mm Hg in the sham-procedure group, for a difference of -1.96 mm Hg (95% CI, -4.97 to 1.06; P=0.98 for superiority with a margin of 2 mm Hg). There were no significant differences in safety between the two groups. CONCLUSIONS This blinded trial did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 months after renal-artery denervation as compared with a sham control. (Funded by Medtronic; SYMPLICITY HTN-3 ClinicalTrials.gov number, NCT01418261.).
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Affiliation(s)
- Deepak L Bhatt
- From Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B., L.M.), Boston University School of Public Health (R.D.), and Harvard Clinical Research Institute (R.D., L.M.) - all in Boston; Piedmont Heart Institute, Atlanta (D.E.K.); the Division of Cardiology, Henry Ford Hospital (W.W.O.), and Wayne State University and the Detroit Medical Center (J.M.F.) - all in Detroit; Baptist Cardiac and Vascular Institute, Miami (B.T.K.); New York Presbyterian Hospital, Columbia University Medical Center, and Cardiovascular Research Foundation, New York (M.B.L.); Medtronic CardioVascular, Santa Rosa, CA (M.L., M.N., S.A.C.); University of Alabama at Birmingham, Birmingham (S.O.); Prairie Heart Institute, Springfield, IL (K.R.-S.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.A.C., R.R.T.); and University of Chicago Medicine, Chicago (G.L.B.)
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Feres F, Costa RA, Abizaid A, Leon MB, Marin-Neto JA, Botelho RV, King SB, Negoita M, Liu M, de Paula JET, Mangione JA, Meireles GX, Castello HJ, Nicolela EL, Perin MA, Devito FS, Labrunie A, Salvadori D, Gusmão M, Staico R, Costa JR, de Castro JP, Abizaid AS, Bhatt DL. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA 2013; 310:2510-22. [PMID: 24177257 DOI: 10.1001/jama.2013.282183] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [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: 12/15/2022]
Abstract
IMPORTANCE The current recommendation is for at least 12 months of dual antiplatelet therapy after implantation of a drug-eluting stent. However, the optimal duration of dual antiplatelet therapy with specific types of drug-eluting stents remains unknown. OBJECTIVE To assess the clinical noninferiority of 3 months (short-term) vs 12 months (long-term) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) with zotarolimus-eluting stents. DESIGN, SETTING, AND PATIENTS The OPTIMIZE trial was an open-label, active-controlled, 1:1 randomized noninferiority study including 3119 patients in 33 sites in Brazil between April 2010 and March 2012. Clinical follow-up was performed at 1, 3, 6, and 12 months. Eligible patients were those with stable coronary artery disease or history of low-risk acute coronary syndrome (ACS) undergoing PCI with zotarolimus-eluting stents. INTERVENTIONS After PCI with zotarolimus-eluting stents, patients were prescribed aspirin (100-200 mg daily) and clopidogrel (75 mg daily) for 3 months (n = 1563) or 12 months (n = 1556), unless contraindicated because of occurrence of an end point. MAIN OUTCOMES AND MEASURES The primary end point was net adverse clinical and cerebral events (NACCE; a composite of all-cause death, myocardial infarction [MI], stroke, or major bleeding); the expected event rate at 1 year was 9%, with a noninferiority margin of 2.7%. Secondary end points were major adverse cardiac events (MACE; a composite of all-cause death, MI, emergent coronary artery bypass graft surgery, or target lesion revascularization) and Academic Research Consortium definite or probable stent thrombosis. RESULTS NACCE occurred in 93 patients receiving short-term and 90 patients receiving long-term therapy (6.0% vs 5.8%, respectively; risk difference, 0.17 [95% CI, -1.52 to 1.86]; P = .002 for noninferiority). Kaplan-Meier estimates demonstrated MACE rates at 1 year of 8.3% (128) in the short-term group and 7.4% (114) in the long-term group (HR, 1.12 [95% CI, 0.87-1.45]). Between 91 and 360 days, no statistically significant association was observed for NACCE (39 [2.6%] vs 38 [2.6%] for the short- and long-term groups, respectively; HR, 1.03 [95% CI, 0.66-1.60]), MACE (78 [5.3%] vs 64 [4.3%]; HR, 1.22 [95% CI, 0.88-1.70]), or stent thrombosis (4 [0.3%] vs 1 [0.1%]; HR, 3.97 [95% CI, 0.44-35.49]). CONCLUSIONS AND RELEVANCE In patients with stable coronary artery disease or low-risk ACS treated with zotarolimus-eluting stents, 3 months of dual antiplatelet therapy was noninferior to 12 months for NACCE, without significantly increasing the risk of stent thrombosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01113372.
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Affiliation(s)
- Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Ricardo A Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Alexandre Abizaid
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Martin B Leon
- New York Presbyterian Medical Center, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York
| | | | - Roberto V Botelho
- Instituto do Coração do Triângulo Mineiro, Uberlândia, Minas Gerais, Brazil
| | | | | | - Minglei Liu
- Medtronic CardioVascular, Santa Rosa, California
| | | | - José A Mangione
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - George X Meireles
- Hospital Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | | | | | - André Labrunie
- Santa Casa de Misericórdia de Marilia, Marilia, São Paulo, Brazil
| | - Décio Salvadori
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos Gusmão
- Hospital Agamenon Magalhães, Recife, Pernambuco, Brazil
| | - Rodolfo Staico
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - J Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Böhm M, Mahfoud F, Ukena C, Bauer A, Fleck E, Hoppe UC, Kintscher U, Narkiewicz K, Negoita M, Ruilope L, Rump LC, Schlaich M, Schmieder R, Sievert H, Weil J, Williams B, Zeymer U, Mancia G. Rationale and design of a large registry on renal denervation: the Global SYMPLICITY registry. EUROINTERVENTION 2013; 9:484-92. [DOI: 10.4244/eijv9i4a78] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Diletti R, Garcia-Garcia HM, Bourantas CV, van Geuns RJ, Van Mieghem NM, Vranckx P, Zhang YJ, Farooq V, Iqbal J, Wykrzykowska JJ, de Vries T, Swart M, Teunissen Y, Negoita M, van Leeuwen F, Silber S, Windecker S, Serruys PW. Clinical outcomes after zotarolimus and everolimus drug eluting stent implantation in coronary artery bifurcation lesions: insights from the RESOLUTE All Comers Trial. Heart 2013; 99:1267-74. [PMID: 23800571 DOI: 10.1136/heartjnl-2013-303778] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We investigated clinical outcomes after treatment of coronary bifurcation lesions with second generation drug eluting stents (DES). DESIGN Post hoc analysis of a randomised, multicentre, non-inferiority trial. SETTING Multicentre study. PATIENTS All comers study with minimal exclusion criteria. INTERVENTIONS Patients were treated with either zotarolimus or everolimus eluting stents. The patient population was divided according to treatment of bifurcation or non-bifurcation lesions and clinical outcomes were compared between groups. MAIN OUTCOMES MEASURES Clinical outcomes within 2-year follow-up. RESULTS A total of 2265 patients were included in the present analysis. Two-year follow-up data were available in 2223 patients: 1838 patients in the non-bifurcation group and 385 patients in the bifurcation group. At 2-year follow-up the bifurcation and the non-bifurcation lesion groups showed no significant differences in terms of cardiac death (2.3 vs 2.1, p=0.273), target lesion failure (9.7% vs 13.8%, p=0.255), major adverse cardiac events (11.5% vs 15.1%, p=0.305), target lesion revascularisation (4.7% vs 6.0%, p=0.569), and definite or probable stent thrombosis (1.6% vs 1.8%, p=0.419). CONCLUSIONS The use of second generation DES for the treatment of coronary bifurcation lesions was associated with similar long term mortality and clinical outcomes compared with non-bifurcation lesions.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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11
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Farooq V, Vranckx P, Mauri L, Cutlip DE, Belardi J, Silber S, Widimsky P, Leon M, Windecker S, Meredith I, Negoita M, van Leeuwen F, Neumann FJ, Yeung AC, Garcia-Garcia HM, Serruys PW. Impact of overlapping newer generation drug-eluting stents on clinical and angiographic outcomes: pooled analysis of five trials from the international Global RESOLUTE Program. Heart 2013; 99:626-33. [DOI: 10.1136/heartjnl-2012-303368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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12
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Kandzari DE, Bhatt DL, Sobotka PA, O'Neill WW, Esler M, Flack JM, Katzen BT, Leon MB, Massaro JM, Negoita M, Oparil S, Rocha-Singh K, Straley C, Townsend RR, Bakris G. Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 2012; 35:528-35. [PMID: 22573363 PMCID: PMC6652693 DOI: 10.1002/clc.22008] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [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: 02/27/2012] [Revised: 04/11/2012] [Indexed: 12/11/2022] Open
Abstract
Hypertension represents a significant global public health concern, contributing to vascular and renal morbidity, cardiovascular mortality, and economic burden. The opportunity to influence clinical outcomes through hypertension management is therefore paramount. Despite adherence to multiple available medical therapies, a significant proportion of patients have persistent blood pressure elevation, a condition termed resistant hypertension. Recent recognition of the importance of the renal sympathetic and somatic nerves in modulating blood pressure and the development of a novel procedure that selectively removes these contributors to resistant hypertension represents an opportunity to provide clinically meaningful benefit across wide and varied patient populations. Early clinical evaluation with catheter-based, selective renal sympathetic denervation in patients with resistant hypertension has mechanistically correlated sympathetic efferent denervation with decreased renal norepinephrine spillover and renin activity, increased renal plasma flow, and has demonstrated clinically significant, sustained reductions in blood pressure. The SYMPLICITY HTN-3 Trial is a pivotal study designed as a prospective, randomized, masked procedure, single-blind trial evaluating the safety and effectiveness of catheter-based bilateral renal denervation for the treatment of uncontrolled hypertension despite compliance with at least 3 antihypertensive medications of different classes (at least one of which is a diuretic) at maximal tolerable doses. The primary effectiveness endpoint is measured as the change in office-based systolic blood pressure from baseline to 6 months. This manuscript describes the design and methodology of a regulatory trial of selective renal denervation for the treatment of hypertension among patients who have failed pharmacologic therapy.
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13
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Fleming LM, Novack V, Novack L, Cohen SA, Negoita M, Cutlip DE. Frequency and impact of bleeding in elective coronary stent clinical trials--utility of three commonly used definitions. Catheter Cardiovasc Interv 2012; 80:E23-9. [PMID: 22109802 DOI: 10.1002/ccd.23332] [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] [Received: 03/08/2011] [Accepted: 08/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bleeding events are common after percutaneous coronary intervention (PCI) and have been shown to increase mortality in studies of acute coronary syndrome (ACS) and anti-thrombotic therapy. Despite this evidence, bleeding has not been included as a traditional major endpoint in clinical trials of low-risk populations enrolled in PCI clinical trials. Thus, the impact of specific bleeding definitions has not been evaluated fully among these patients. METHODS AND RESULTS Using patient-level pooled data from sirolimus and zotarolimus drug-eluting stent clinical trials, we identified bleeding events using three common definitions of bleeding, ACUITY, TIMI, and GUSTO, and assessed the impact on mortality and MI at 12 months after PCI. The GUSTO, ACUITY, and TIMI classifications identified bleeding rates of 2.3%, 1.9%, and 2.1%, respectively. The GUSTO criteria classified all 118 suspected bleeding events. There were 22 (18.6%) and 8 (6.8%) suspected bleeding events that did not meet ACUITY and TIMI criteria, respectively. The combined endpoint of all-cause death or myocardial infarction (MI) at 12 months was significantly higher for patients with a bleeding event compared with those who did not bleed [hazard ratio 1.95 (95% CI 1.06-3.60)]. CONCLUSION There is a substantial variability in the utility and inclusiveness of three widely used bleeding definitions in identifying clinically significant bleeding events in clinical trials of low risk patients undergoing PCI with DES. Patients with bleeding after elective PCI have an increased one-year risk of death or MI compared to those patients who do not bleed.
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Affiliation(s)
- Lisa M Fleming
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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14
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Mauri L, Leon MB, Yeung AC, Negoita M, Keyes MJ, Massaro JM. Rationale and design of the clinical evaluation of the Resolute Zotarolimus-Eluting Coronary Stent System in the treatment of de novo lesions in native coronary arteries (the RESOLUTE US clinical trial). Am Heart J 2011; 161:807-14. [PMID: 21570508 DOI: 10.1016/j.ahj.2011.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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] [Received: 12/30/2010] [Accepted: 03/09/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) are commonly used to treat obstructive coronary disease and avoid restenosis. Newer DES have been developed to improve effectiveness and safety. We describe a clinical trial to evaluate a DES with a novel polymer that may improve the antirestenosis effectiveness while maintaining the safety standards of currently Food and Drug Administration-approved DES. METHODS The RESOLUTE US Trial is a multicenter, nonrandomized trial prospectively designed to compare the Resolute zotarolimus-eluting stent (R-ZES) to the Food and Drug Administration-approved Endeavor ZES using patient-level historical control data, adjusting for baseline covariates through propensity score. The stents differ primarily in the polymer, which, in the R-ZES, is designed to elute zotarolimus over a longer period. The study will enroll up to 1,574 patients with ischemic heart disease due to de novo native coronary lesions suitable for 1- or 2-vessel treatment with stents from 2.25 to 4.0 mm in diameter. The primary end point is target lesion failure at 12 months postprocedure, defined as the composite of cardiac death, target-vessel myocardial infarction (MI), and clinically driven target lesion revascularization by percutaneous or surgical methods. Secondary end points include device, lesion and procedural success, death, MI, cardiac death and MI, composites of these clinical events, and stent thrombosis at each follow-up assessment up to 5 years postprocedure. CONCLUSIONS The RESOLUTE US Trial (ClinicalTrials.gov #NCT00726453) is a prospective, multicenter, observational study with a patient-level historical control designed to assess the safety and efficacy of the R-ZES for the treatment of de novo lesions in native coronary arteries.
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Affiliation(s)
- Laura Mauri
- Brigham and Women's Hospital, Boston, MA 02115, USA.
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15
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Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt G, Buszman PE, Kelbaek H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli A, Ronden J, Bressers M, Gobbens P, Negoita M, van Leeuwen F, Windecker S. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med 2010; 363:136-46. [PMID: 20554978 DOI: 10.1056/nejmoa1004130] [Citation(s) in RCA: 513] [Impact Index Per Article: 36.6] [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: 02/02/2023]
Abstract
BACKGROUND New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed by the Food and Drug Administration. METHODS In this multicenter, noninferiority trial with minimal exclusion criteria, we randomly assigned 2292 patients to undergo treatment with coronary stents releasing either zotarolimus or everolimus. Twenty percent of patients were randomly selected for repeat angiography at 13 months. The primary end point was target-lesion failure, defined as a composite of death from cardiac causes, any myocardial infarction (not clearly attributable to a nontarget vessel), or clinically indicated target-lesion revascularization within 12 months. The secondary angiographic end point was the extent of in-stent stenosis at 13 months. RESULTS At least one off-label criterion for stent placement was present in 66% of patients. The zotarolimus-eluting stent was noninferior to the everolimus-eluting stent with respect to the primary end point, which occurred in 8.2% and 8.3% of patients, respectively (P<0.001 for noninferiority). There were no significant between-group differences in the rate of death from cardiac causes, any myocardial infarction, or revascularization. The rate of stent thrombosis was 2.3% in the zotarolimus-stent group and 1.5% in the everolimus-stent group (P=0.17). The zotarolimus-eluting stent was also noninferior regarding the degree (+/-SD) of in-stent stenosis (21.65+/-14.42% for zotarolimus vs. 19.76+/-14.64% for everolimus, P=0.04 for noninferiority). In-stent late lumen loss was 0.27+/-0.43 mm in the zotarolimus-stent group versus 0.19+/-0.40 mm in the everolimus-stent group (P=0.08). There were no significant between-group differences in the rate of adverse events. CONCLUSIONS At 13 months, the new-generation zotarolimus-eluting stent was found to be noninferior to the everolimus-eluting stent in a population of patients who had minimal exclusion criteria. (ClinicalTrials.gov number, NCT00617084.)
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Affiliation(s)
- Patrick W Serruys
- Department of Cardiology, Erasmus Medical Center, Molewaterplein 40, Ba-583, 3015 GD Rotterdam, The Netherlands.
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16
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Meredith IT, Worthley S, Whitbourn R, Walters DL, McClean D, Horrigan M, Popma JJ, Cutlip DE, DePaoli A, Negoita M, Fitzgerald PJ. Clinical and angiographic results with the next-generation resolute stent system: a prospective, multicenter, first-in-human trial. JACC Cardiovasc Interv 2010; 2:977-85. [PMID: 19850258 DOI: 10.1016/j.jcin.2009.07.007] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 07/17/2009] [Accepted: 07/25/2009] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The RESOLUTE trial examined the safety and efficacy of a next-generation zotarolimus-eluting coronary stent, Resolute (Medtronic CardioVascular Inc., Santa Rosa, California). BACKGROUND Revascularization benefits associated with current drug-eluting stents are often diminished in the presence of complex coronary lesions and in certain patient cohorts. Resolute uses a new proprietary polymer coating that extends the duration of drug delivery to match the longer healing duration often experienced in more complex cases. METHODS The RESOLUTE trial was a prospective, nonrandomized, multicenter study of the Resolute stent in 139 patients with de novo coronary lesions with reference vessel diameters > or =2.5 and < or =3.5 mm and lesion length > or =14 and < or =27 mm. The primary end point was 9-month in-stent late lumen loss by quantitative coronary angiography. Secondary end points included major adverse cardiac events (MACE) at 30 days, 6, 9, and 12 months; acute device, lesion, and procedure success; and 9-month target vessel failure (TVF), target lesion revascularization (TLR), stent thrombosis, neointimal hyperplastic (NIH) volume, and percent NIH volume obstruction. RESULTS The 9-month in-stent late lumen loss was 0.22 +/- 0.27 mm. Cumulative MACE were 4.3%, 4.3%, 7.2%, and 8.7% at 30 days, 6, 9, and 12 months, respectively. Acute lesion, procedure, and device success rates were 100.0%, 95.7%, and 99.3%, respectively. At 9 months, TLR was 0.0%, TVF was 6.5%, stent thrombosis was 0.0%, NIH volume was 6.55 +/- 7.83 mm(3), and percent NIH volume obstruction was 3.73 +/- 4.05%. CONCLUSIONS In this feasibility study, the Resolute stent demonstrated low in-stent late lumen loss, minimal neointimal hyperplastic ingrowth, low TLR, no stent thrombosis, and acceptable TVF and MACE. (The RESOLUTE Clinical Trial; NCT00248079).
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Affiliation(s)
- Ian T Meredith
- Monash Heart Monash Medical Centre and University, Melbourne, Australia.
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17
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Adam OR, Ferrara JM, Aguilar Tabora LG, Nashatizadeh MM, Negoita M, Jankovic J. Education research: patient telephone calls in a movement disorders center: lessons in physician-trainee education. Neurology 2009; 73:e50-2. [PMID: 19738167 DOI: 10.1212/wnl.0b013e3181b6bb7f] [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: 11/15/2022] Open
Abstract
OBJECTIVE Telephone medicine is part of clinical practice, but there are no published data on the volume, nature, and time allocation of patient-related telephone calls received in a movement disorders center. Such data might provide insights which augment patient care, and may be instructive regarding medical education, since patient-related telephone calls are often addressed by physicians-in-training. METHODS Characteristics of patient-related calls to a movement disorders center were prospectively recorded during a 2-month period. RESULTS A total of 633 calls were generated by 397 patients. The average time per call was 6.6 +/- 4.7 minutes. Disease-related questions (35.1%), treatment-related questions (21.3%), and side effect reports (15.3%) represented the majority of calls. Patients with Parkinson disease, Tourette syndrome (TS), and atypical parkinsonism (AP) called more frequently, while patients with dystonia and tremor called less frequently. CONCLUSION Patient telephone calls contribute substantially to the patient care in a movement disorders center and represent an important aspect of training, providing an opportunity for movement disorders fellows to develop independent decision-making skills and monitor effectiveness of their physician-patient counseling. Parkinson disease, Tourette syndrome (TS), and atypical parkinsonism (AP) contribute disproportionately to the total patient telephone volume, possibly due to coexisting obsessive-compulsive and impulse-control comorbidities in patients with TS, and complications or a change of diagnosis and prognosis in patients with AP. Emphasis on the management of these specific diagnostic groups early in fellowship training may be warranted.
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Affiliation(s)
- O R Adam
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
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18
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Tsuchiya Y, Lansky AJ, Costa RA, Mehran R, Pietras C, Shimada Y, Sonoda S, Cristea E, Negoita M, Dangas GD, Moses JW, Leon MB, Fitzgerald PJ, Müller R, Störger H, Hauptmann KE, Grube E. Effect of everolimus-eluting stents in different vessel sizes (from the pooled FUTURE I and II trials). Am J Cardiol 2006; 98:464-9. [PMID: 16893698 DOI: 10.1016/j.amjcard.2006.02.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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: 12/23/2005] [Revised: 02/09/2006] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
The everolimus-eluting stent (EES) has been shown to significantly decrease neointimal proliferation at 6 months compared with the bare metal stent (BMS) in patients with de novo coronary lesions. We report mid-term outcomes based on different vessel sizes in the combined FUTURE I and II trials. In the prospective, randomized, FUTURE I trial (single center) and expanded FUTURE II trial (multicenter), 106 patients (107 lesions) were randomized to EESs (n = 49 lesions) or BMSs (n = 58 lesions). Patients were categorized into 3 groups based on preprocedure reference diameter as assessed by quantitative coronary angiography (small vessel < 2.75 mm, medium vessel 2.75 to 3.25 mm, and large vessel > 3.25 mm). At 6-month follow-up, EESs decreased in-stent late lumen loss (decreased rate range of 78% to 94%), resulting in significantly larger minimum lumen area as assessed by intravascular ultrasound (increased range of 34% to 42%) compared with the BMS across all vessel sizes. There were no cases of in-stent restenosis with EESs at any vessel size but 8 cases with BMSs (5 in small vessels). No stent thrombosis, aneurysm formation, or late stent incomplete apposition was observed in any group. The EES appears to be effective for treatment of de novo coronary lesions in decreasing neointimal proliferation at 6-month follow-up compared with BMSs, regardless of vessel size.
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Affiliation(s)
- Yoshihiro Tsuchiya
- The Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York, USA
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19
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Price MJ, Moses JW, Leon MB, Mehran R, Negoita M, Lansky A, Collins M, Giap H, Lin R, Jani S, Steuterman S, Balter S, Dalton J, Lipsztein R, Tripuraneni P, Teirstein PS. A multicenter, randomized, dose-finding study of gamma intracoronary radiation therapy to inhibit recurrent restenosis after stenting. J Invasive Cardiol 2006; 18:169-73. [PMID: 16732060] [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: 05/09/2023]
Abstract
OBJECTIVES The objective of this double-blind, randomized study was to determine the safety and efficacy of intracoronary radiation therapy (ICRT) with a dose of 17 Gray (Gy) compared to the currently recommended dose prescription of 14 Gy for the treatment of in-stent restenosis within bare metal stents. BACKGROUND While gamma ICRT for in-stent restenosis has been proven efficacious, the optimal dose is unknown, and radiation failure due to recurrent neointimal hyperplasia remains a significant clinical problem for some patients. A higher radiation dose may improve outcomes, but may potentially increase adverse events. METHODS Following coronary intervention, 336 patients with in-stent restenosis were randomly assigned to receive ICRT with either 14 Gy or 17 Gy at 2 mm from an 192-iridium source. RESULTS At 8-month follow up, fewer patients in the 17 Gy group underwent target lesion revascularization (TLR = 15.2% versus 27.2%; p = 0.01), target vessel revascularization (21.3% versus 33.1%; p = 0.02), or reached the composite endpoint of death, myocardial infarction, thrombosis, or TLR (17.1% versus 28.4%; p = 0.02). There were no differences in late thrombosis or mortality between treatment groups. There was a strong trend toward reduced in-lesion late loss (0.36 +/- 0.63 mm vs. 0.51 +/- 0.64 mm; p = 0.09) and a significantly lower rate of binary restenosis (23.9% versus 38.1%; p = 0.031) in the high dose group. CONCLUSIONS Gamma ICRT with 17 Gy is safe and, compared to 14 Gy, reduces recurrent stenosis and clinical events at 8-month follow up. An increase in the currently recommended gamma radiation dose prescription from 14 Gy to 17 Gy should be strongly considered.
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Affiliation(s)
- Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
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20
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Nikolsky E, Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Negoita M, Lansky AJ, Mehran R. Impact of body mass index on outcomes after primary angioplasty in acute myocardial infarction. Am Heart J 2006; 151:168-75. [PMID: 16368312 DOI: 10.1016/j.ahj.2005.03.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [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] [Received: 06/14/2004] [Accepted: 03/15/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prognostic importance of obesity after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is unknown. We therefore sought to investigate the impact of body mass index (BMI) in patients with AMI undergoing primary PCI. METHODS In the CADILLAC trial, 2082 patients of any age with AMI within 12 hours onset undergoing primary PCI were randomized to balloon angioplasty versus stenting, each +/-abciximab. Outcomes were stratified by baseline BMI. RESULTS Baseline BMI was measured in 2035 (98%) randomized patients; 552 (27%) patients have normal weight (BMI < 25 kg/m2), 915 (45%) were overweight (> or = 25 to < 30 kg/m2), and 568 (28%) were obese (> or = 30 kg/m2). Compared with normal-weight patients, obese patients were younger and more frequently had diabetes, hyperlipidemia, hypertension, non-anterior myocardial infarction, and higher creatinine clearance. Obese patients were less likely to develop thrombocytopenia (1.8% vs 4.2%), moderate hemorrhagic complications (1.4% vs 3.3%), or required blood product transfusions (3.2% vs 6.3%) (all P < or = .04). Obese compared with normal-weight patients had lower inhospital mortality (0.9% vs 2.7%, P = .03) at 30 days (1.1% vs 3.8%, P = .02) and 1 year (1.8% vs 7.5%, P < .0001). Independent predictors of 30-day and 1-year mortality included lower ejection fraction, advanced age, 3-vessel disease, anterior AMI, and lower creatinine clearance, but not BMI. CONCLUSIONS Obese patients with AMI have an improved prognosis after primary PCI compared with normal-weight patients, a finding attributable to AMI onset at younger age, with better renal function and less anterior infarction.
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Mehran R, Nikolsky E, Camenzind E, Zelizko M, Kranjec I, Seabra-Gomes R, Negoita M, Slack S, Lotan C. An Internet-based registry examining the efficacy of heparin coating in patients undergoing coronary stent implantation. Am Heart J 2005; 150:1171-6. [PMID: 16338254 DOI: 10.1016/j.ahj.2005.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 07/07/2004] [Accepted: 01/18/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heparin coating is an attractive alternative to counterbalance intrinsic stent thrombogenicity and to decrease the incidence of stent thrombosis. METHODS We compared, based on the data of an international multicenter prospective registry, the rates of stent thrombosis after percutaneous coronary interventions in native coronary arteries using a Bx VELOCITY heparin-coated stent versus a bare metal stent of the same design in a total of 3098 patients at high risk for stent thrombosis. Most patients in both groups underwent percutaneous coronary intervention for unstable angina (48.4% vs 47.5%, respectively) with > 25% of the patients treated for acute myocardial infarction (30.8% and 28.1%, respectively). RESULTS Procedural success was high and very similar in patients with heparin-coated and bare metal stents (99.3% vs 98.8%, respectively, P = .11). The primary end point, a 30-day stent thrombosis, occurred in 0.6% of the 1417 patients treated with the heparin-coated stent and 0.9% of the 1681 patients treated with the bare metal stent (relative risk reduction 33%, P = .41). The rates of cardiac death, myocardial infarction, and target lesion revascularization did not differ significantly between the groups. By multivariate analysis, variables independently associated with 30-day stent thrombosis included the evidence of thrombus at baseline (odds ratio [OR] 3.0, 95% CI 1.29-7.0, P = .01), small vessel stenting (OR 2.41, 95% CI 1.01-5.74, P = .05), and target left anterior descending artery (OR 2.32, 95% CI 1.00-5.38, P = .05). CONCLUSION This large-scale registry comparing the use of heparin-coated stent versus bare metal stent in the reality of daily practice showed no significant difference in stent thrombosis in patients with a high-risk profile for thrombotic complications.
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Affiliation(s)
- Roxana Mehran
- Cardiovascular Research Foundation, New York, NY 10022, USA.
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22
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Lansky AJ, Pietras C, Costa RA, Tsuchiya Y, Brodie BR, Cox DA, Aymong ED, Stuckey TD, Garcia E, Tcheng JE, Mehran R, Negoita M, Fahy M, Cristea E, Turco M, Leon MB, Grines CL, Stone GW. Gender Differences in Outcomes After Primary Angioplasty Versus Primary Stenting With and Without Abciximab for Acute Myocardial Infarction. Circulation 2005; 111:1611-8. [PMID: 15811868 DOI: 10.1161/01.cir.0000160362.55803.40] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women with acute myocardial infarction (AMI) undergoing primary angioplasty have higher rates of morbidity and mortality than do men. Whether contemporary interventional treatment strategies have improved outcomes for women compared with men is unknown. METHODS AND RESULTS In the CADILLAC trial, 2082 patients (27% women) with AMI within 12 hours of symptom onset were randomized to balloon angioplasty (PTCA; n=518), PTCA+abciximab (n=528), stenting (n=512), and stenting+abciximab (n=524). As compared with men, women had a lower body surface area; had a greater prevalence of diabetes, hypertension, and hyperlipidemia; experienced significant delays to treatment; and had better baseline and final TIMI grade 3 flows. Unadjusted 1-year event rates were higher for women, including death (7.6% versus 3.0%, P<0.001), ischemic target-vessel revascularization (TVR; 16.7% versus 12.1%, P=0.006), and major adverse cardiac events (MACE; 23.9% versus 15.3%, P<0.001). Female gender was an independent predictor of MACE and bleeding complications, although comorbid risk factors and body surface area but not gender predicted 1-year death. For women, primary stenting resulted in a reduction in 1-year MACE from 28.1% to 19.1% (P=0.01) and in ischemic TVR from 20.4% to 10.8% (P=0.002) compared with PTCA. The addition of abciximab to primary stenting significantly reduced the 30-day ischemic TVR without increasing bleeding or stroke rates. CONCLUSIONS The higher mortality rate in women compared with men after interventional treatment for AMI may be explained by differences in body size and clinical risk factors, although female gender remains an important independent determinant of overall adverse outcomes. For women in the CADILLAC trial, the addition of abciximab reduced 30-day TVR without increasing bleeding risk, and primary stenting reduced 1-year TVR and MACE rates compared with PTCA.
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Affiliation(s)
- Alexandra J Lansky
- College of Physicians and Surgeons, Columbia University, and the Cardiovascular Research Foundation, New York, NY 10022, USA.
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Nikolsky E, Mehran R, Lasic Z, Mintz GS, Lansky AJ, Na Y, Pocock S, Negoita M, Moussa I, Stone GW, Moses JW, Leon MB, Dangas G. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int 2005; 67:706-13. [PMID: 15673320 DOI: 10.1111/j.1523-1755.2005.67131.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between low hematocrit and contrast-induced nephropathy has not been investigated. METHODS Of 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of >/=25% or >/=0.5 mg/dL in preprocedure serum creatinine, at 48 hours postprocedure) occurred in 942 (13.9%) patients. RESULTS Rates of contrast-induced nephropathy steadily increased as baseline hematocrit quintile decreased (from 10.3% in the highest quintile to 23.3% in the lowest quintile) (chi(2) for trend, P < 0.0001). Stratification by baseline estimated glomerular filtration rate (eGFR) and baseline hematocrit showed that the rates of contrast-induced nephropathy were the highest (28.8%) in patients who had the lowest level for both baseline eGFR and hematocrit. Patients with the lowest eGFR but relatively high baseline hematocrit values had remarkably lower rates of contrast-induced nephropathy (15.8%, 12.3%, 17.1%, and 15.4% in 2nd, 3rd, 4th, and 5th quintiles of baseline hematocrit, respectively) (P < 0.0001). The rates of contrast-induced nephropathy increased with increment in change in hematocrit. Patients in the lowest quintile of baseline hematocrit with absolute hematocrit drop >5.9% had almost doubled rates of contrast-induced nephropathy compared with patients with hematocrit change <3.4% (38.1% vs. 18.8%, respectively) (P < 0.0001). By multivariate analysis, lower baseline hematocrit was an independent predictor of contrast-induced nephropathy; each 3% decrease in baseline hematocrit resulted in a significant increase in the odds of contrast-induced nephropathy in patients with and without chronic kidney disease (11% and 23%, respectively). When introduced into the multivariate model instead of baseline hematocrit, change in hematocrit also showed a significant association with contrast-induced nephropathy. CONCLUSION Lower hematocrit is an important risk factor for contrast-induced nephropathy. Whether correcting the hematocrit prepercutaneous coronary intervention might decrease the rates of contrast-induced nephropathy should be addressed in a prospectively designed trial.
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Costa RA, Lansky AJ, Mintz GS, Mehran R, Tsuchiya Y, Negoita M, Gilutz Y, Nikolsky E, Fahy M, Pop R, Cristea E, Carlier S, Dangas G, Stone GW, Leon MB, Müller R, Techen G, Grube E. Angiographic results of the first human experience with everolimus-eluting stents for the treatment of coronary lesions (the FUTURE I trial). Am J Cardiol 2005; 95:113-6. [PMID: 15619406 DOI: 10.1016/j.amjcard.2004.08.074] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [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: 08/04/2004] [Revised: 08/24/2004] [Accepted: 08/24/2004] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to report the angiographic findings of the first human evaluation of the everolimus-eluting stent (EES) for the treatment of noncomplex coronary lesions. Forty-two patients with de novo coronary lesions (2.75 to 4.00 mm vessels; lesion length, <18 mm) were prospectively randomized in a 2:1 ratio to receive either the EES (n = 27) or a metallic stent (n = 15). Baseline clinical and angiographic characteristics were similar among both groups. At 6-month follow-up, EES had a lower in-stent late lumen loss (0.10 +/- 0.22 vs 0.85 +/- 0.32 mm, p <0.0001) and in-segment diameter stenoses (20.7 +/- 12.3% vs 37.0 +/- 15.8%, p = 0.002). There was no in-stent restenosis with EES; however, 1 focal distal edge restenosis was present. There was 1 in-stent and 1 in-segment (proximal edge) restenosis in the metallic stent group. There was no stent thrombosis or aneurysm formation at follow-up in either group.
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Affiliation(s)
- Ricardo A Costa
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA
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Nikolsky E, Mehran R, Halkin A, Aymong ED, Mintz GS, Lasic Z, Negoita M, Fahy M, Krieger S, Moussa I, Moses JW, Stone GW, Leon MB, Pocock SJ, Dangas G. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol 2004; 44:1200-9. [PMID: 15364320 DOI: 10.1016/j.jacc.2004.06.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [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: 02/18/2004] [Revised: 06/01/2004] [Accepted: 06/09/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was designed to assess the safety of arteriotomy closure devices (ACDs) versus mechanical compression by meta-analysis in patients undergoing percutaneous transfemoral coronary procedures. BACKGROUND Although ACDs are widely applied for hemostasis after percutaneous endovascular procedures, their safety is controversial. METHODS Randomized, case-control, and cohort studies comparing access-related complications using ACDs versus mechanical compression were analyzed. The primary end point was the cumulative incidence of vascular complications, including pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, access site infection, and blood transfusion. RESULTS A total of 30 studies involving 37,066 patients were identified. No difference in complication incidence between Angio-Seal and mechanical compression was revealed in the diagnostic (Dx) setting (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.11 to 10.0) or percutaneous coronary interventions (PCI) (OR 0.86, 95% CI 0.65 to 1.12). Meta-analysis of randomized trials only showed a trend toward less complications using Angio-Seal in a PCI setting (OR 0.46, 95% CI 0.20 to 1.04; p = 0.062). No differences were observed regarding Perclose in either Dx (OR 1.51, 95% CI 0.24 to 9.47) or PCI (OR 1.21, 95% CI 0.94 to 1.54) setting. An increased risk in complication rates using VasoSeal in the PCI setting (OR 2.25, 95% CI 1.07 to 4.71) was found. The overall analysis favored mechanical compression over ACD (OR 1.34, 95% CI 1.01 to 1.79). CONCLUSIONS In the setting of Dx angiography, the risk of access-site-related complications was similar for ACD compared with mechanical compression. In the setting of PCI, the rate of complications appeared higher with VasoSeal.
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Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation and the Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA
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Nikolsky E, Mehran R, Aymong ED, Mintz GS, Lansky AJ, Lasic Z, Negoita M, Fahy M, Pocock SJ, Na Y, Krieger S, Moses JW, Stone GW, Leon MB, Dangas G. Impact of anemia on outcomes of patients undergoing percutaneous coronary interventions. Am J Cardiol 2004; 94:1023-7. [PMID: 15476616 DOI: 10.1016/j.amjcard.2004.06.058] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Revised: 06/28/2004] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
Of 6,929 consecutive patients who were treated with percutaneous coronary intervention, 1,708 (24.6%) had anemia according to criteria of the World Health Organization. Compared with patients who did not have anemia, those who did have anemia were older, more frequently women and African-American, had a smaller body mass index, and higher frequencies of cardiovascular risk factors and co-morbid conditions. Patients who had anemia compared with those who did not have anemia had significantly (p <0.0001) higher mortality rates during hospitalization (1.9% vs 0.4%) and at 1 year (12.8% vs 3.5%). After adjustment for potential confounders, baseline hematocrit remained a significant predictor of a 1-year mortality rate (hazard ratio 0.93 per 1% increase in hematocrit, 95% confidence interval 0.91 to 0.95).
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Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA
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Nikolsky E, Aymong ED, Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Cohen DA, Negoita M, Lansky AJ, Stone GW. Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 2004; 44:547-53. [PMID: 15358018 DOI: 10.1016/j.jacc.2004.03.080] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [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] [Received: 01/12/2004] [Revised: 02/24/2004] [Accepted: 03/11/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to investigate the impact of anemia in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND The prognostic importance of anemia on primary PCI outcomes is unknown. METHODS In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 2,082 patients of any age with AMI within 12 h onset undergoing primary PCI were randomized to balloon angioplasty versus stenting, each +/- abciximab. Outcomes were stratified by the presence of anemia at baseline, as defined by World Health Organization criteria (hematocrit <39% for men and <36% for women). RESULTS Anemia was present in 260 (12.8%) of 2,027 randomized patients with baseline laboratory values. Patients with versus without baseline anemia more frequently developed in-hospital hemorrhagic complications (6.2% vs. 2.4%, p = 0.002), had higher rates of blood product transfusions (13.1% vs. 3.1%, p < 0.0001), and had a prolonged (median 4.1 vs. 3.5 days, p < 0.0001) and more expensive (median costs $12,434 vs. $11,603, p = 0.002) index hospitalization. Patients with versus without anemia had strikingly higher mortality during hospitalization (4.6% vs. 1.1%, p = 0.0003), at 30 days (5.8% vs. 1.5%, p < 0.0001), and at 1 year (9.4% vs. 3.5%, p < 0.0001). The rates of disabling stroke at 30 days (0.8% vs. 0.1%, p = 0.005) and at 1 year (2.1% vs. 0.4%, p = 0.0007) were also significantly higher in patients with anemia. By multivariate analysis, anemia was an independent predictor of in-hospital mortality (hazard ratio, 3.26; p = 0.048) and one-year mortality (hazard ratio, 2.38; p = 0.016). CONCLUSIONS Anemia at baseline in patients with AMI undergoing primary PCI is common, and is strongly associated with adverse outcomes and increased mortality.
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Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation, New York, New York 10022, USA
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Nikolsky E, Mehran R, Dangas GD, Lasic Z, Mintz GS, Negoita M, Lansky AJ, Stone GW, Moussa I, Iyer S, Na Y, Moses JW, Leon MB. Prognostic significance of cerebrovascular and peripheral arterial disease in patients having percutaneous coronary interventions. Am J Cardiol 2004; 93:1536-9. [PMID: 15194030 DOI: 10.1016/j.amjcard.2004.03.010] [Citation(s) in RCA: 19] [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: 12/22/2003] [Revised: 03/01/2004] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
This study shows that cerebrovascular and peripheral arterial diseases frequently co-exist in patients with coronary artery disease who undergo percutaneous coronary interventions. These 2 conditions are associated with adverse in-hospital and 1-year outcomes and independently predict early and 1-year mortality.
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Costa RA, Lansky AJ, Mehran R, Tsuchiya Y, Cristea E, Gilutz Y, Coral M, Negoita M, Pop R, Rink M, Muller R, Techen G, Grube E. 1059-6 The multicenter evaluation of the everolimus-eluting stent for inhibition of neointimal hyperplasia: Results of the pooled FUTURE I and II trials. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90045-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Costa RA, Lansky AJ, Costantini CO, Tsuchiya Y, Caluser C, Sahid B, Fahy M, Nikolsky E, Aymong E, Negoita M, Mehran R, Cox DA, Grines CL, Stone GW. 801-2 Predictors of survival after primary percutaneous coronary intervention: The impact of myocardial perfusion grade in female patients. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91133-3] [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: 10/26/2022]
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Grube E, Costa RA, Mehran R, Negoita M, Gilutz Y, Tsuchiya Y, Fahy M, Cristea E, Sahid B, Marginean H, Muller R, Techen G, Rinck M, Lansky AJ, Hauptmann KE, Storger H. 843-2 Everolimus-eluting stents for the prevention of restenosis: Results of the FUTURE II trial. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90361-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tsuchiya Y, Lansky AJ, Costa RA, Mehran R, Negoita M, Cristea E, Marginean H, Corral M, Tarawali M, Babb J, Cox DA, Stone GW. 830-5 The impact of myocardial blush grade on clinical outcomes of patients treated with saphenous vein grafts and thrombotic native coronary arteries: Analysis from the X-TRACT trial. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90300-2] [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: 11/25/2022]
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Nikolsky E, Mehran R, Mintz GS, Dangas GD, Lansky AJ, Aymong ED, Negoita M, Fahy M, Moussa I, Roubin GS, Moses JW, Stone GW, Leon MB. Impact of Symptomatic Peripheral Arterial Disease on 1-Year Mortality in Patients Undergoing Percutaneous Coronary Interventions. J Endovasc Ther 2004. [DOI: 10.1583/1545-1550(2004)011<0060:iospad>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stone GW, Mehran R, Midei M, Waksman R, Schaer GL, Negoita M, Lansky AJ, Buchbinder M. Usefulness of beta radiation for de novo and in-stent restenotic lesions in saphenous vein grafts. Am J Cardiol 2003; 92:312-4. [PMID: 12888142 DOI: 10.1016/s0002-9149(03)00635-0] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Following successful angioplasty of 49 saphenous vein graft lesions, a novel, self-centering phosphorus-32 solid foil beta source encapsulated within a dual-balloon membrane was used to deliver 20 Gy 1 mm into the vessel wall. Clinical and angiographic recurrence rates at 12 months were low, especially in de novo lesions.
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Affiliation(s)
- Gregg W Stone
- Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA.
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Abizaid AS, Mehran R, Mintz GS, Abizaid AA, Dangas G, Lansky AJ, Farkouh M, Adamian MG, Aymong ED, Negoita M, Hjazi I, Costantini C, Kobayashi Y, Moses JW, Stone GW, Leon MB. Impact of diabetes on coronary remodeling in patients with acute coronary syndromes: An intravascular ultrasound study. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Madrid AP, Grise MA, Reilly JP, Moses JW, Leon MB, Tcelibi A, Cioar C, Giap H, Jani S, Balter S, Tripuraneni P, Lansky A, Negoita M, Mehran R, Teirstein PS. Coronary brachytherapy is an effective treatment for chronic in-stent total occlusions. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80207-3] [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: 11/30/2022]
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Lansky AJ, Mehran R, Dangas G, Desai K, Costantini-Ortiz C, Cristea E, New G, Negoita M, Stone GW, Leon MB. New-device angioplasty in women: clinical outcome and predictors in a 7,372-patient registry. Epidemiology 2002; 13 Suppl 3:S46-51. [PMID: 12071484 DOI: 10.1097/00001648-200205001-00010] [Citation(s) in RCA: 14] [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: 11/26/2022]
Abstract
BACKGROUND Female gender has been identified as an independent predictor of early complications and mortality after conventional balloon angioplasty. To gain insight into the outcome of women after new-device angioplasty, we reviewed the early and late clinical outcome of 7,372 patients undergoing new-device angioplasty between 1991 and 1996 at the Washington Hospital Center. METHODS Patients (2,077 women and 5,295 men) with native coronary artery (82.5%) or saphenous vein graft lesions undergoing new-device angioplasty were included in the study. In-hospital and 1-year major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization (TLR), were recorded and compared on the basis of gender. Multivariable logistic regression analysis was performed to identify predictors of in-hospital and late mortality, follow-up MACE, and TLR. RESULTS Women had more baseline comorbid risk factors and smaller reference vessel size compared with men. Women had a higher in-hospital cardiac mortality (1.39% vs 0.66%, P = 0.002), TLR (2.78% vs 1.81%, P = 0.008), and congestive heart failure (4.18% vs 2.29%, P < 0.001) compared with men. Overall in-hospital MACE tended to be higher among women (4.2% vs 3.3%, P = 0.074). Women had a higher 1-year mortality rate (4.39% vs 3.26%, P = 0.018), but a lower follow-up TLR (15.0% vs 18.1%, P = 0.001) and a lower overall MACE rate (29.2% vs 32.7%, P = 0.007) compared with men. Female gender was an independent predictor of in-hospital mortality (odds ratio 2.28, P = 0.02), but not late mortality. CONCLUSIONS Although female gender appears to carry an inherent risk of in-hospital mortality after new-device angioplasty, the procedural success and mortality rates are favorable compared with those associated with balloon angioplasty series. The long-term clinical outcome of women after new-device angioplasty is excellent. The use of new devices is a safe and effective alternative strategy for the treatment of women with ischemic coronary artery disease. Device-specific outcomes, including stents, will require further evaluation.
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Affiliation(s)
- Alexandra J Lansky
- Cardiac Catheterization Laboratory and the Women's Cardiac Health Initiative, Lenox Hill Hospital, New York City, NY 10022, USA.
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Teirstein PS, Moses JW, Leon MB, Casterella PJ, Reilly JP, Glap H, Jani S, Balter S, Tripuraneni P, Lansky A, Negoita M, Mehran R. Prolonged antiplatelet therapy and reduced stenting eliminates late thrombosis after radiation: the SCRIPPS III trial. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80281-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Adamian MG, Mehran R, Dangas G, Farkhou M, Abizaid A, Reyes A, Hjazi I, Negoita M, Mohamed M, Cioara C, Pop R, Lansky AJ, Stone GW, Moses JW, Leon MB. Stenting in acute myocardial infarction in patients with chronic renal failure: predictors of in-hospital and long-term outcome. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81388-2] [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: 10/27/2022]
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Lakovou I, Dangas G, Lansky A, Negoita M, Hjazi I, Ashby D, Forman J, Guiry M, Brandwein R, Losquadro M, Limpijankit T, Stone G, Moses J, Leon M, Mehran R. Predictors of contrast induced nephropathy after percutaneous coronary intervention in patients with and without chronic renal failure. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80243-1] [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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Iakovou I, Dangas G, Lansky A, Negoita M, Hjazi I, Ashby D, Costantini C, Guiry M, Brandwein R, Losquadro M, Forman J, Moses J, Stone G, Leon M, Mehran R. Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80004-3] [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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Grise MA, Negoita M, Mehran R, Tripuraneni P, Reilly JP, Moses JW, Leon MB, Teirstein PS. The impact of new stent implantation on outcomes following intracoronary brachytherapy. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80275-3] [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: 11/15/2022]
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