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Saito S, Bennett J, Nef HM, Webster M, Namiki A, Takahashi A, Kakuta T, Yamazaki S, Shibata Y, Scott D, Vrolix M, Menon M, Möllmann H, Werner N, Neylon A, Mehmedbegovic Z, Smits PC, Morice MC, Verheye S. First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT. EClinicalMedicine 2023; 65:102304. [PMID: 38106564 PMCID: PMC10725075 DOI: 10.1016/j.eclinm.2023.102304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function. Methods This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747). Findings 445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), pnon-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001). Interpretation This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function. Funding The study was funded by Elixir Medical.
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Affiliation(s)
- Shigeru Saito
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | - Holger M. Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Mark Webster
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
| | | | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Douglas Scott
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
| | - Madhav Menon
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Nikos Werner
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Antoinette Neylon
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Pieter C. Smits
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | - BIOADAPTOR-RCT Collaborators
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
- Department of Cardiology, Takahashi Hospital, Kobe City, Japan
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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van den Buijs DMF, Poels EM, Ferdinande B, Cottens D, Vrolix M, Dauw J, Dens J, Ameloot K. Comparison of Radifocus versus Silverway Guidewires for Percutaneous Radial Angiography Following Failed Use of a J-Tip Guidewire. Med Sci Monit 2023; 29:e939429. [PMID: 37025045 PMCID: PMC10088458 DOI: 10.12659/msm.939429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND During transradial coronary angiography, when conventional J-tip wires fail to deliver catheters to the aortic root due to anatomical obstacles, additional hydrophilic wires, such as Radifocus (Terumo) or Silverway (Asahi), are used. We recently showed that the Silverway guidewire was effective at delivering the catheter to the aortic root. In this study, we aimed to compare the efficacy and safety of Radifocus and Silverway guidewires in 100 patients after failed use of the J-tip guidewire. MATERIAL AND METHODS After patients had a failure of a conventional J-tip wire to reach the aortic root, 100 patients were 1:1 randomized to either the Silverway or Radifocus wire. All patients with failure of the J-tip wire were eligible. The primary endpoint was the time between wire entry in the catheter and successful delivery of the catheter to the aortic root. Secondary endpoints included change of access site, number of complications, and questionnaires on subjective wire assessments by the performing interventional cardiologist. RESULTS The primary endpoint was significantly shorter in patients randomized to the Silverway arm (median 30 s [21-39] vs 48 s [36-66]; P<0.001)). The percentage of patients with change of access site was not different between the groups (2 vs 2, not significant). Only 1 minor complication (2%) occurred, in the Radifocus group. Questionnaires revealed that torque control, crossing, and support were all significantly better with the Silverway wire (P<0.001). CONCLUSIONS Silverway showed superior torque control, resulting in faster catheter delivery to the aortic root when compared with the Radifocus guidewire.
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Affiliation(s)
| | - Ella M Poels
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
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3
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Verheye S, Colombo A, Vrolix M, Montorfano M, Zivelonghi C, Giannini F, Bedogni F, Dubois C, De Bruyne B, Costa R, Chamie D, Costa J, Kereiakes D, Abizaid A, Zhu M. TCT-157 A Novel “Uncaging” DynamX Bioadaptor Restores Vascular Pulsatility, Vasomotion and Adaptive Remodelling: Final 36-Month Clinical Results and 12-Month Imaging Data. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.184] [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: 10/14/2022]
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Bor WL, de Veer AJW, Olie RH, Rikken SA, Chan Pin Yin DR, Herrman JPR, Vrolix M, Meuwissen M, Vandendriessche T, van Mieghem C, Magro M, Bennaghmouch N, Hermanides R, Adriaenssens T, Dewilde WJ, ten Berg JM. Dual versus triple antithrombotic therapy after percutaneous coronary intervention: the prospective multicentre WOEST 2 Study. EUROINTERVENTION 2022; 18:e303-e313. [PMID: 35370126 PMCID: PMC9980408 DOI: 10.4244/eij-d-21-00703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND For patients on oral anticoagulants (OAC) undergoing percutaneous coronary intervention (PCI), European guidelines have recently changed their recommendations to dual antithrombotic therapy (DAT; P2Y12 inhibitor and OAC) without aspirin. AIMS The prospective WOEST 2 registry was designed to obtain contemporary real-world data on antithrombotic regimens and related outcomes after PCI in patients with an indication for OAC. METHODS In this analysis, we compare DAT (P2Y12 inhibitor and OAC) to triple antithrombotic therapy (TAT; aspirin, P2Y12 inhibitor, and OAC) on thrombotic and bleeding outcomes after one year. Clinically relevant bleeding was defined as Bleeding Academic Research Consortium classification (BARC) grade 2, 3, or 5; major bleeding as BARC grade 3 or 5. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause mortality, myocardial infarction, stent thrombosis, ischaemic stroke, and transient ischaemic attack. RESULTS A total of 1,075 patients were included between 2014 and 2021. Patients used OAC for atrial fibrillation (93.6%) or mechanical heart valve prosthesis (4.7%). Non-vitamin K oral anticoagulants (NOAC) were prescribed in 53.1% and vitamin K antagonists in 46.9% of patients. At discharge, 60.9% received DAT, and 39.1% TAT. DAT was associated with less clinically relevant and similar major bleeding (16.8% vs 23.4%; p<0.01 and 7.6% vs 7.7%, not significant), compared to TAT. The difference in MACCE between the two groups was not statistically significant (12.4% vs 9.7%; p=0.17). Multivariable adjustment and propensity score matching confirmed these results. CONCLUSIONS Dual antithrombotic therapy is associated with a substantially lower risk of clinically relevant bleeding without a statistically significant penalty in ischaemic events.
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Affiliation(s)
- Willem Lambertus Bor
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | | | - Renske H. Olie
- Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sem A.O.F. Rikken
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands,Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | - Carlos van Mieghem
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium,Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Michael Magro
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Naoual Bennaghmouch
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Rick Hermanides
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Jurriën Maria ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands,Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
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5
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Abstract
BACKGROUND This study aimed to assess the reliability of pressure derived fractional flow reserve (FFR) measurement and the handling performance of the OptoWire Deux with an optical pressure sensor relative to both the PressureWire X and the Verrata Pressure wire with piezoresistive pressure sensors. METHODS This single centre study included 80 patients between October 2016 and May 2017 undergoing a diagnostic coronary angiography. The reliability of FFR measurement measured with the OptoWire Deux relative to the PressureWire X and Verrata Pressure wire was assessed by the presence of drift. Drift was defined as a Pd/Pa measurement different from 1.00 ± 0.02 when pulled back after a FFR measurement at the location of the initial equalisation. Handling characteristics for all pressure wires were assessed qualitatively with respect to the PressureWire Aeris. RESULTS Ninety-eight measurements in 78 patients were performed; two patients were excluded because the lesion could not be crossed. Very stable and reliable FFR measurements with the optical sensors were registered, relative to the piezoresistive pressure sensors. Drift was found in 11%, 37%, and 33% of the measurements for OptoWire Deux, PressureWire X, and Verrata Pressure wire respectively. The handling performance of the OptoWire Deux was better rated for steerability and torqueability in relation to the standard FFR wire. The handling of the PressureWire X was rated equally good whereas the handling of the Verrata pressure wire was rated inferior in relation to the standard FFR wire. CONCLUSIONS In patients undergoing FFR measurement, the OptoWire Deux has a stable and reliable pressure hence FFR measurement with fewer drift events and has good handling characteristics.
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Affiliation(s)
- Daan Cottens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Joren Maeremans
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | | | - Jo Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
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6
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de Veer AJWM, Bennaghmouch N, Bor WL, Herrman JPR, Vrolix M, Meuwissen M, Vandendriessche T, Adriaenssens T, de Bruyne B, Magro M, Dewilde WJM, Ten Berg JM. The WOEST 2 registry : A prospective registry on antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention. Neth Heart J 2022; 30:302-311. [PMID: 35230636 PMCID: PMC9123099 DOI: 10.1007/s12471-022-01664-0] [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] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain insight into antithrombotic management over time. Methods A prospective cohort study of patients on OACs for atrial fibrillation or a mechanical heart valve undergoing PCI was performed. Thrombotic outcomes were myocardial infarction, stroke, target-vessel revascularisation and all-cause mortality. Bleeding outcome was any bleeding. We report the 30-day outcome. Results The mean age of the 758 patients was 73.5 ± 8.2 years. The CHA2DS2-VASc score was ≥ 3 in 82% and the HAS-BLED score ≥ 3 in 44%. At discharge, 47% were on vitamin K antagonists (VKAs), 52% on NOACs, 43% on triple therapy and 54% on dual therapy. Treatment with a NOAC plus clopidogrel increased from 14% in 2014 to 67% in 2019. The rate of thrombotic (4.5% vs 2.0%, p = 0.06) and bleeding (17% vs. 14%, p = 0.42) events was not significantly different in patients on VKAs versus NOACs. Also, the rate of thrombotic (2.9% vs 3.4%, p = 0.83) and bleeding (18% vs 14%, p = 0.26) events did not differ significantly between patients on triple versus dual therapy. Conclusions Patients on combined oral anticoagulation and antiplatelet therapy undergoing PCI are elderly and have both a high bleeding and ischaemic risk. Over time, a NOAC plus clopidogrel became the preferred treatment. The rate of thrombotic and bleeding events was not significantly different between patients on triple or dual therapy or between those on VKAs versus NOACs. Supplementary Information The online version of this article (10.1007/s12471-022-01664-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A J W M de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - N Bennaghmouch
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - W L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J P R Herrman
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - M Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - T Vandendriessche
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | - B de Bruyne
- Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium
| | - M Magro
- Department of Cardiology, Elizabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - W J M Dewilde
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Cottens D, Ferdinande B, Polad J, Vrolix M, Ameloot K, Hendrickx I, Poels E, Maeremans J, Dens J. FFR pressure wire comparative study for drift: piezo resistive versus optical sensor. Am J Cardiovasc Dis 2022; 12:42-52. [PMID: 35291508 PMCID: PMC8918737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to assess the stability of pressure derived fractional flow reserve (FFR) measurement and the handling performance of the OptoWire Deux with an optical pressure sensor relative to the PressureWire X with piezo resistive pressure sensors. METHODS This multicenter centre observational study included 50 patients between June 2017 and November 2018 undergoing a diagnostic coronary angiography with FFR measurement of moderate to severe lesions. The reliability of FFR measurement measured with the OptoWire Deux relative to the PressureWire X in each lesion was assessed by the presence of drift. Handling characteristics for both pressure wires were assessed by a 5-point scale and by comparing the time between equalization and crossing the distal target lesion. RESULTS Hundred and sixteen measurements in 50 patients were performed. Very stable and reliable FFR measurements with the optical sensors were registered, relative to the piezo resistive pressure sensors. There is statistically significant difference in favor of the OptoWire Deux over the PressureWire X (P=0.001). However, the differences are small, when drift values were compared as continuous variables, no statistically significant difference was found for both directional (P=0.435) as for absolute drift (P=0.058). CONCLUSIONS In patients undergoing FFR measurement, both optical sensor pressure wires (Optowire Deux) as piezo resistive sensor pressure wires (PressureWire X) generate stable and reliable pressure and thus FFR measurement. The optical pressure sensor is less susceptible for drift relative to the piezo resistive pressure sensor, but the difference is within an acceptable range.
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Affiliation(s)
- Daan Cottens
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Jawed Polad
- Department of Cardiology, Hospital Jeroen Bosch’s HertogenboschThe Netherlands
| | - Mathias Vrolix
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Koen Ameloot
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Ief Hendrickx
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Ella Poels
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
| | - Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit HasseltBelgium
| | - Jo Dens
- Department of Cardiology, Hospital Oost-LimburgGenk, Belgium
- Faculty of Medicine and Life Sciences, Universiteit HasseltBelgium
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8
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Colombo A, Vrolix M, Montorfano M, Bedogni F, Dubois C, de Bruyne B, Giannini F, Zivelonghi C, Abizaid A, Costa R, Costa J, Kereiakes D, Verheye S. TCT-487 DynamX Bioadaptor, a Novel “Uncaging” Platform for Coronary Artery Revascularization: Final 36-Month Clinical Results. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1340] [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: 11/26/2022]
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Dauw J, Martens P, Deferm S, Bertrand P, Nijst P, Hermans L, Van den Bergh M, Housen I, Hijjit A, Warnants M, Cottens D, Ferdinande B, Vrolix M, Dens J, Ameloot K, Dupont M, Mullens W. Left ventricular function recovery after ST-elevation myocardial infarction: correlates and outcomes. Clin Res Cardiol 2021; 110:1504-1515. [PMID: 34091698 DOI: 10.1007/s00392-021-01887-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contemporary data on left ventricular function (LVF) recovery in patients with left ventricular dysfunction after ST-elevation myocardial infarction (STEMI) are scarce and to date, no comparison has been made with patients with a baseline normal LVF. This study examined predictors of LVF recovery and its relation to outcomes in STEMI. METHODS Patients presenting with STEMI between January 2010 and December 2016 were categorized in three groups after 3 months according to left ventricular ejection fraction (EF): (i) baseline normal LVF (EF ≥ 50% at baseline); (ii) recovered LVF (EF < 50% at baseline and ≥ 50% after 3 months); and (iii) reduced LVF (EF < 50% at baseline and after 3 months). Heart failure hospitalization, all-cause mortality and cardiovascular mortality were compared between the three groups. RESULTS Of 577 patients, 341 (59%) patients had a baseline normal LVF, 112 (19%) had a recovered LVF and 124 (22%) had a reduced LVF. Independent correlates of LVF recovery were higher baseline EF, lower peak troponin and cardiac arrest. After median 5.8 years, there was no difference in outcomes between patients with LVF recovery and baseline normal LVF. In contrast, even after multivariate adjustment, patients with persistently reduced LVF had a higher risk for heart failure hospitalization (HR 5.00; 95% CI 2.17-11.46) and all-cause mortality (HR 1.87; 95% CI 1.11-3.16). CONCLUSION In contemporary treated STEMI patients, prognosis is significantly worse in those with a persistently reduced LVF after 3 months, compared with patients with a baseline normal LVF and those with LVF recovery.
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Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. .,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium.
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Philippe Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Lowie Hermans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mats Van den Bergh
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Isabel Housen
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Amin Hijjit
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Maarten Warnants
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, LCRC, UHasselt, Diepenbeek, Belgium
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Leonardi S, Branca M, Franzone A, McFadden E, Piccolo R, Jüni P, Vranckx P, Steg PG, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Heg D, Windecker S, Valgimigli M. Comparison of Investigator-Reported and Clinical Event Committee-Adjudicated Outcome Events in GLASSY. Circ Cardiovasc Qual Outcomes 2021; 14:e006581. [PMID: 33535773 DOI: 10.1161/circoutcomes.120.006581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Event adjudication by a clinical event committee (CEC) provides a standardized, independent outcome assessment. However, the added value of CEC to investigators reporting remains debated. GLASSY (GLOBAL LEADERS Adjudication Sub-Study) implemented, in a subset of the open-label, investigator-reported (IR) GLOBAL LEADERS trial, an independent adjudication process of reported and unreported potential outcome events (triggers). We describe metrics of GLASSY feasibility and efficiency, diagnostic accuracy of IR events, and their concordance with corresponding CEC-adjudicated events. METHODS We report the proportion of myocardial infarction, bleeding, stroke, and stent thrombosis triggers with sufficient evidence for assessment (feasibility) that were adjudicated as outcome events (efficiency), stratified by source (IR or non-IR). Using CEC-adjudicated events as criterion standard, we describe sensitivity, specificity, positive and negative predictive value, and global diagnostic accuracy of IR events. Using Gwet AC coefficient, we examine the concordance between IR- and corresponding CEC-adjudicated triggers. There was sufficient evidence for assessment for 2592 (98.3%) of 2636 triggers. RESULTS Overall, the adjudicated end point-to-trigger ratio was high and similar between IR- (88%) and non-IR-reported (87%) triggers. The global diagnostic accuracy and concordance between IR-reported and CEC-adjudicated outcome events was 0.70 (95% CI, 0.65-0.74) and 0.54 (95% CI, 0.45-0.62), respectively, for myocardial infarction; 0.77 (95% CI, 0.75-0.79) and 0.71 (95% CI, 0.68-0.74) for bleeding; 0.70 (95% CI, 0.62-0.79) and 0.59 (95% CI, 0.43-0.74) for stroke; 0.59 (95% CI, 0.52-0.66) and 0.39 (95% CI, 0.25-0.53) for stent thrombosis. For IR bleedings, the concordance with the CEC on type of events was generally weak. CONCLUSIONS Implementing CEC adjudication in a pragmatic open-label trial with IR events is feasible and efficient. Our findings of modest global diagnostic accuracy for IR events and generally weak concordance between investigators and CEC support the role for CEC adjudication in such settings. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03231059.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Italy (S.L.).,Coronary Care Unit (S.L.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Mattia Branca
- Clinical Trials Unit Bern (M.B.), University of Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Eugene McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands (E.M.).,Department of Cardiology, Cork University Hospital, Ireland (E.M.)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Peter Jüni
- Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada (P.J.)
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium (P.V.)
| | | | - Patrick W Serruys
- Department of Cardiology, Imperial College of London, United Kingdom (P.W.S.)
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium (E.B.)
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.)
| | - Luc Janssens
- German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Maurizio Ferrario
- Division of Cardiology (M.F.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Department of Interventional Cardiology, American Heart of Poland SA, Chrzanów (A.Z.)
| | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (R.D.)
| | | | - Kurt Huber
- 3rd Medical Department, Cardiology, Wilhelminen Hospital, Vienna, Austria (K.H.)
| | - Ton Slagboom
- Sigmund Freud University Medical School, Vienna, Austria (K.H.)
| | - Pawel Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Ustroń (P.B.).,Department of Epidemiology and Statistics, Medical University of Silesia, Katowice, Poland (P.B.)
| | | | - Carlo Tumscitz
- Cardiology Unit Sant'Anna Hospital, Ferrara, Italy (C.T.)
| | - Krzysztof Bryniarski
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (K.B.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria (I.P.)
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom (S.G.)
| | - Cristoph Naber
- Contilia Heart and Vascular Centre, Stadtspital Triemli, Zürich, Switzerland (C.N.)
| | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.).,German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H.), University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland (M. Valgimigli)
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11
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Verheye S, Vrolix M, Montorfano M, Zivelonghi C, Giannini F, Bedogni F, Dubois C, De Bruyne B, Costa RA, Chamié D, de Ribamar Costa J, Kereiakes DJ, Abizaid AA, Colombo A. Twelve-month clinical and imaging outcomes of the uncaging coronary DynamX bioadaptor system. EUROINTERVENTION 2020; 16:e974-e981. [PMID: 32894231 DOI: 10.4244/eij-d-20-00763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to assess the safety and efficacy of the DynamX Novolimus-Eluting Coronary Bioadaptor System, a novel device that initially acts as a second-generation drug-eluting stent, but after six months frees the vessel through uncaging elements. METHODS AND RESULTS This multicentre study enrolled 50 patients with single de novo lesions. In-device acute lumen gain was 1.61±0.34 mm, and device and procedure success was 100%. Up to 12 months, two target lesion failures occurred: both were cardiac deaths (day 255 and day 267 post procedure). No definite or probable device thrombosis was observed. Mean late lumen loss was 0.12±0.18 mm in-device and 0.11±0.16 mm in-segment. Per intravascular ultrasound, the mean device area and mean vessel area increased significantly by 5% and 3%, respectively, while the mean lumen area was maintained. Stationary optical coherence tomography in seven patients demonstrated restoration of cyclic pulsatility, with an approximate lumen area variance of 11% between systole and diastole. CONCLUSIONS The DynamX bioadaptor showed drug-eluting stent-like acute performance and safety and efficacy up to one year. Positive remodelling with an increase of vessel and device area while maintaining the mean lumen area was demonstrated. Long-term follow-up and randomised trials are required to assess the benefit of this device on events beyond one year.
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Affiliation(s)
- Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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12
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Ono M, Tomaniak M, Koenig W, Khamis R, de Silva R, Chichareon P, Kawashima H, Hara H, Gao C, Wang R, Huber K, Vrolix M, Jasionowicz P, Wykrzykowska JJ, Piek JJ, Jüni P, Hamm C, Steg PG, Windecker S, Onuma Y, Storey RF, Serruys PW. Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial. European Heart Journal - Cardiovascular Pharmacotherapy 2020; 8:39-47. [DOI: 10.1093/ehjcvp/pvaa110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 01/17/2023]
Abstract
Abstract
Aims
The aim of this study was to investigate the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to the baseline white blood cell (WBC) count.
Methods and results
This is a post hoc analysis of the GLOBAL LEADERS trial, a multi-centre, open-label, randomized all-comer trial in patients undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual anti-platelet therapy [DAPT]) with the reference strategy (12-month aspirin monotherapy following 12-month DAPT). Patients were stratified into two WBC groups, either < or ≥median WBC count of 7.8 × 109 cells/L (lower or higher WBC group, respectively). The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years. Of 14 576 patients included in the present study, 7212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy was associated with a significant lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group [2.8% vs. 4.2%; hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.52–0.86] but not in the higher WBC group (4.8% vs. 4.7%; HR: 1.01; 95% CI: 0.82–1.25; Pinteraction=0.013). There were no significant differences in the risks of Bleeding Academic Research Consortium type 3 or 5 bleeding between two anti-platelet strategies regardless of the WBC groups.
Conclusion
Increased WBC counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic benefits of ticagrelor monotherapy observed in patients with lower WBC counts.
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Affiliation(s)
| | - Mariusz Tomaniak
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam 3015 GD, the Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw 02-091, Poland
| | - Wolfgang Koenig
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich 80636, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance 10785, Germany
| | - Ramzi Khamis
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
| | - Ranil de Silva
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield National Health Service Foundation Trust, London SW3 6NP, UK
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Chao Gao
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
- Department of Cardiology, Xijing Hospital, Xi’an 710032, China
| | - Rutao Wang
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
- Department of Cardiology, Xijing Hospital, Xi’an 710032, China
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital and Sigmund Freud University, Medical Faculty, 1020 Wien, Austria
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk 3600, Belgium
| | - Pawel Jasionowicz
- Department of Cardiology, Polsko-Amerykańskie Kliniki Serca (PAKS) Nysa 48-300, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Peter Jüni
- Department of Cardiology, Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto M5B 1T8, Canada
| | - Christian Hamm
- Department of Cardiology, University of Giessen and Kerckhoff Heartand Thorax Center, University of Giessen, Bad Nauheim 35390, Germany
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université de Paris, Assistance Publique-Hôpitaux de Paris -Diderot, Paris 75006, France
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, 3010 Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TG, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
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13
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Gragnano F, Heg D, Franzone A, McFadden EP, Leonardi S, Piccolo R, Vranckx P, Branca M, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg PG, Jüni P, Windecker S, Valgimigli M. PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY. Eur Heart J Cardiovasc Pharmacother 2020; 8:28-38. [PMID: 32941620 DOI: 10.1093/ehjcvp/pvaa106] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022]
Abstract
AIMS The 5-item PRECISE-DAPT, integrating age, haemoglobin, white-blood-cell count, creatinine clearance, and prior bleeding, predicts bleeding risk in patients on dual antiplatelet therapy (DAPT) after stent implantation. We sought to assess whether the bleeding risk prediction offered by the PRECISE-DAPT remains valid among patients receiving ticagrelor monotherapy from 1 month onwards after coronary stenting instead of standard DAPT and having or not having centrally-adjudicated bleeding endpoints. METHODS AND RESULTS The PRECISE-DAPT was calculated in 14,928 and 7,134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict BARC 3 or 5 bleeding was assessed and compared among patients on ticagrelor monotherapy (experimental strategy) or standard DAPT (reference strategy) from 1 month after drug-eluting stent implantation. Bleeding endpoints were investigator-reported or centrally-adjudicated in GLOBAL LEADERS and GLASSY, respectively.At 2 years, the c-indexes for the score among patients treated with the experimental or reference strategy were 0.67 (95% confidence interval [CI]:0.63-0.71) vs. 0.63 (95% CI:0.59-0.67) in GLOBAL LEADERS (p = 0.27), and 0.67 (95% CI:0.61-0.73) vs. 0.66 (95% CI:0.61-0.72) in GLASSY (p = 0.88). Decision curve analysis showed net benefit using the PRECISE-DAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified 4-item PRECISE-DAPT. CONCLUSIONS The PRECISE-DAPT offers a prediction model that proved similarly effective to predict clinically-relevant bleeding among patients on ticagrelor monotherapy from 1 month after coronary stenting compared with standard DAPT and appears to be unaffected by the presence or absence of adjudicated bleeding endpoints.
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Affiliation(s)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Eugène P McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands and Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium
| | - Mattia Branca
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Patrick W Serruys
- Department of Cardiology, Imperial College of London, London, United Kingdom
| | - Edouard Benit
- Jessa Hospital, Department of Cardiology, Hasselt, Belgium
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany
| | | | - Maurizio Ferrario
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Kurt Huber
- 3rd Medical Department, Cardiology, Wilhelminenhospital, and Sigmund Freud University Medical School, Vienna, Austria
| | | | - Paweł Buszman
- Center for Cardiovascular Research and Development American Heart of Poland, and Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | | | | | - Krzysztof Bryniarski
- Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Adel Aminian
- Department of cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | | | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK); Partner site RheinMain, Frankfurt am Main, Germany
| | | | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
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14
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Verheye S, Wlodarczak A, Montorsi P, Bennett J, Torzewski J, Haude M, Vrolix M, Buck T, Aminian A, van der Schaaf RJ, Nuruddin AA, Lee MK. Twelve-month outcomes of 400 patients treated with a resorbable metal scaffold: insights from the BIOSOLVE-IV registry. EUROINTERVENTION 2020; 15:e1383-e1386. [DOI: 10.4244/eij-d-18-01058] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Verheye S, Vrolix M, Giannini F, Montorfano M, Bedogni F, Dubois C, De Bryne B, Costa R, Costa J, Chamie D, Abizaid A, Kereiakes D, Colombo A. CRT-100.89 DynamX Bioadaptor, A Novel “Uncaging” Platform for Coronary Artery Revascularization: 12-Month Clinical and Imaging Results. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.074] [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: 11/29/2022]
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16
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Takahashi K, Kogame N, Tomaniak M, Chichareon P, Chang CC, Modolo R, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, van Geuns RJ, Dominici M, Huber K, Buszman P, Bolognese L, Tumscitz C, Żmudka K, Aminian A, Vrolix M, Petrov I, Wykrzykowska JJ, de Winter RJ, Hamm C, Steg PG, Onuma Y, Valgimigli M, Windecker S, Vranckx P, Garg S, Serruys PW. Impact of recruitment and retention on all-cause mortality in a large all-comers randomised controlled trial: insights from the GLOBAL LEADERS trial. Clin Res Cardiol 2019; 109:918-929. [PMID: 31828504 DOI: 10.1007/s00392-019-01585-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recruitment and retention in trials may bias the results and subsequently complicate their interpretation and validity. The aim of this study is to evaluate the impact of recruitment and retention on all-cause mortality in a large all-comers trial. METHODS The recruitment rate in each investigating center of the GLOBAL LEADERS trial was assessed and the 130 centers were subdivided into low and high recruiters according to the median, with all-cause mortality then compared between the two groups. Vital status was obtained from public records in patients with incomplete follow-up. RESULTS The trial randomized 15,991 (7.86%) of 203,483 eligible patients with percutaneous coronary intervention during the recruitment period, of whom 15,267 (95.47%) completed follow-up, 23 (0.14%) patients withdrew consent and formally requested to be deleted from the database; 183 (1.14%) withdrew consent but only objected to future data collection; 303 (1.89%) discontinued the study; and 215 (1.34%) were lost to follow-up. Vital status was finally obtained in all but 31 patients (99.81%). Patients from low recruiters had a significantly lower all-cause mortality than high ones (2.26% vs. 3.24%; hazard ratio: 0.69; 95% confidence interval: 0.55-0.87; p = 0.002). There was a significant difference in all-cause mortality among the incomplete follow-up groups (log-rank p < 0.001) with a significantly higher mortality in the 183 patients who withdrew consent than those who completed follow-up (7.38% vs. 2.99%, p = 0.002). CONCLUSIONS Recruitment and retention significantly impacted all-cause mortality. Search for vital status through public domains is of paramount importance in the interpretation and validity of large clinical trials.
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Affiliation(s)
- Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chun-Chin Chang
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Edouard Benit
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, Hasselt University, Hasselt, Belgium
| | | | | | - Maurizio Ferrario
- UOC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Medical School, Wilhelminen Hospital, and Sigmund Freud University, Vienna, Austria
| | - Pawel Buszman
- American Heart of Poland, Ustroń, Poland
- Department of Epidemiology and Statistics, Medical University of Silesia, Katowice, Poland
| | | | | | - Krzysztof Żmudka
- Department of Interventional Cardiology, Faculty of Medicine, Jagiellonian University, Kraków, Poland
| | - Adel Aminian
- Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium
| | | | | | - Joanna J Wykrzykowska
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Hamm
- Kerckhoff Heartand, Thorax Center, University of Giessen, Bad Nauheim, Germany
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris-Diderot, Paris, France
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
| | - Marco Valgimigli
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Pascal Vranckx
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, Hasselt University, Hasselt, Belgium
| | - Scot Garg
- Royal Blackburn Hospital, Blackburn, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.
- Imperial College London, London, UK.
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Franzone A, McFadden E, Leonardi S, Piccolo R, Vranckx P, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg PG, Heg D, Jüni P, Windecker S, Valgimigli M. Ticagrelor Alone Versus Dual Antiplatelet Therapy From 1 Month After Drug-Eluting Coronary Stenting. J Am Coll Cardiol 2019; 74:2223-2234. [DOI: 10.1016/j.jacc.2019.08.1038] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/17/2022]
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Chichareon P, Onuma Y, van Klaveren D, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Asano T, Katagiri Y, van Geuns RJM, Bolognese L, Tumscitz C, Vrolix M, Petrov I, Garg S, Naber CK, Sabaté M, Iqbal J, Wykrzykowska JJ, Piek JJ, Spitzer E, Jüni P, Hamm C, Steg PG, Valgimigli M, Vranckx P, Windecker S, Serruys PW. Validation of the updated logistic clinical SYNTAX score for all-cause mortality in the GLOBAL LEADERS trial. EUROINTERVENTION 2019; 15:e539-e546. [DOI: 10.4244/eij-d-19-00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Leonardi S, Franzone A, Piccolo R, McFadden E, Vranckx P, Serruys P, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, van Geuns RJ, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg G, Heg D, Juni P, Windecker S, Valgimigli M. Rationale and design of a prospective substudy of clinical endpoint adjudication processes within an investigator-reported randomised controlled trial in patients with coronary artery disease: the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY). BMJ Open 2019; 9:e026053. [PMID: 30852547 PMCID: PMC6429932 DOI: 10.1136/bmjopen-2018-026053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias. METHODS AND ANALYSIS We designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90 mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months followed by aspirin monotherapy for the primary efficacy endpoint of death, non-fatal myocardial infarction, non-fatal stroke or urgent target vessel revascularisation and superior for the primary safety endpoint of type 3 or 5 bleeding according to the Bleeding Academic Research Consortium criteria.This study will comprehensively assess the comparative safety and efficacy of the two tested antithrombotic strategies on CEC-adjudicated ischaemic and bleeding endpoints and will provide insights into the role of a standardised CEC adjudication process on the interpretation of study findings by quantifying the level of concordance between IR-reported and CEC-adjudicated events. ETHICS AND DISSEMINATION GLASSY has been approved by local ethics committee of all study sites and/or by the central ethics committee for the country depending on country-specific regulations. In all cases, they deemed that it was not necessary to obtain further informed consent from individual subjects. TRIAL REGISTRATION NUMBER NCT01813435.
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Affiliation(s)
- Sergio Leonardi
- University of Pavia, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Eugene McFadden
- Department of Cardiology, Cork University Hospital Group, Cork, Ireland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Hasselt, Belgium
| | - Patrick Serruys
- Department of Cardiology, Imperial College of London, London, UK
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Luc Janssens
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Maurizio Ferrario
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | - Marcello Dominici
- Department of Cardiology, S. Maria University-Hospital, Terni, Italy
| | - Kurt Huber
- 3rd Med Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
| | - Ton Slagboom
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - Paweł Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Poland, Poland
| | | | - Carlo Tumscitz
- Department of Cardiology, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Italy
| | - Krzysztof Bryniarski
- Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ivo Petrov
- Department of Cardiology, Adzhibadem Siti Klinik Surdechno-sudovi Center, Sofia, Bulgaria
| | - Scot Garg
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christoph Naber
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre, Essen, Germany
| | | | | | - Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Dik Heg
- CTU, Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern, Switzerland
| | - Peter Juni
- Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland
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Maeremans J, Cottens D, Azzalini L, Pereira B, Godino C, Carlino M, Colombo A, Frambach P, Bellini B, Candilio L, Briguori C, Pierri A, Lamers S, Roux L, Duponselle J, Vrolix M, Dens J. Outcomes of the amphilimus-eluting polymer-free stent for chronic total occlusion treatment: a multicentre experience. J Cardiovasc Med (Hagerstown) 2019; 19:564-570. [PMID: 30124545 DOI: 10.2459/jcm.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Late stent thrombosis and delayed vessel wall healing remain an important issue in coronary vessels treated with drug-eluting stents (DES), especially when long-vessel segments need to be covered, like in chronic total occlusions (CTO). Avoiding polymer use to avoid chronic inflammatory responses is a potential solution to reduce target vessel failure (TVF). We aimed to validate the clinical safety and efficacy at 1 year of the polymer-free Cre8 DES vs. nonpolymer-free DES for the percutaneous treatment of CTO. METHODS Between September 2011 and August 2016, patients were prospectively enrolled in three CTO centres. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, any myocardial infarction, stent thrombosis, TVF and target vessel revascularization. RESULTS A total of 102 Cre8 and 133 non-Cre8 patients were enrolled. At 1 year, a low cumulative MACCE was observed in the Cre8 group (6.9%, respectively). Moreover, a numerical trend towards better MACCE was observed in the Cre8 group vs. the non-Cre8 group (6.9 vs. 14.3%; P = 0.065). The clinically driven TVF rate was not statistically different between Cre8 and non-Cre8 patients (6.9 vs. 9.8%; P = 0.373). A borderline significant difference regarding mortality was observed in favour of Cre8 patients (0 vs. 3.8%; P = 0.049). CONCLUSION Low rates of MACCE and TVF up to 1 year were observed in the Cre8 group, supportive of the use of polymer-free DES for lesions with high complexity.
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Affiliation(s)
- Joren Maeremans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk
| | - Lorenzo Azzalini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Pereira
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Cosmo Godino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter Frambach
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Luciano Candilio
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Adele Pierri
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Scott Lamers
- Faculty of Medicine and Health Sciences - Universiteit Antwerpen, Antwerp, Belgium
| | - Lien Roux
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Jolien Duponselle
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | | | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
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21
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Serruys P, Chichareon P, Modolo R, Kogame N, Takahashi K, Chang CC, Asano T, Katagiri Y, Vrolix M, Zmudka K, Tumscitz C, Bolognese L, Slagboom T, Huber K, Geuns RJV, Vranckx P, Valgimigli M, Windecker S, Onuma Y. TCT-112 Patient-oriented clinical outcomes and net adverse cardiovascular event in the Global Leaders trial. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1213] [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: 11/26/2022]
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22
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Asano T, Katagiri Y, Collet C, Tenekecioglu E, Miyazaki Y, Sotomi Y, Amoroso G, Aminian A, Brugaletta S, Vrolix M, Hernandez-Antolín R, van de Harst P, Íñiguez-Romo A, Janssens L, Smits PC, Wykrzykowska JJ, Ribeiro VG, Pereira H, da Silva PC, Piek JJ, Reiber JH, von Birgelen C, Sabaté M, Onuma Y, Serruys PW. Functional comparison between the BuMA Supreme biodegradable polymer sirolimus-eluting stent and a durable polymer zotarolimus-eluting coronary stent using quantitative flow ratio: PIONEER QFR substudy. EUROINTERVENTION 2018; 14:e570-e579. [DOI: 10.4244/eij-d-17-00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Wijns W, Vrolix M, Verheye S, Schoors D, Slagboom T, Gosselink M, Benit E, Kandzari D, Donohoe D, Ormiston JA. Long-term clinical outcomes of a crystalline sirolimus-eluting coronary stent with a fully bioabsorbable polymer coating: five-year outcomes from the DESSOLVE I and II trials. EUROINTERVENTION 2018; 13:e2147-e2151. [DOI: 10.4244/eij-d-17-00230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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von Birgelen C, Asano T, Amoroso G, Aminian A, Brugaletta S, Vrolix M, Hernandez-Antolín R, van de Harst P, Iñiguez A, Janssens L, Smits PC, Wykrzykowska JJ, Ribeiro VG, Pereira H, da Silva PC, Piek JJ, Onuma Y, Serruys PW, Sabaté M. First-in-man randomised comparison of the BuMA Supreme biodegradable polymer sirolimus-eluting stent versus a durable polymer zotarolimus-eluting coronary stent: the PIONEER trial. EUROINTERVENTION 2018; 13:2026-2035. [DOI: 10.4244/eij-d-17-00462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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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Bennett J, Adriaenssens T, McCutcheon K, Dens J, Desmet W, Sinnaeve P, Vrolix M, Dubois C. 5-Year clinical follow-up of the COBRA (complex coronary bifurcation lesions: Randomized comparison of a strategy using a dedicated self-expanding biolimus A9-eluting stent vs. a culotte strategy using everolimus-eluting stents) study. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- J. Bennett
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
| | - T. Adriaenssens
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; Katholieke Universiteit Leuven; Leuven Belgium
| | - K. McCutcheon
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
| | - J. Dens
- Department of Cardiology; Oost-Limburg Hospital; Genk Belgium
| | - W. Desmet
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; Katholieke Universiteit Leuven; Leuven Belgium
| | - P. Sinnaeve
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; Katholieke Universiteit Leuven; Leuven Belgium
| | - M. Vrolix
- Department of Cardiology; Oost-Limburg Hospital; Genk Belgium
| | - C. Dubois
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; Katholieke Universiteit Leuven; Leuven Belgium
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26
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Maeremans J, Verhaert D, Pereira B, Frambach P, Van Mieghem C, Barbato E, Willems E, Vrolix M, Dens J. One-year clinical and computed tomography follow-up after implantation of bioresorbable vascular scaffolds in patients with coronary chronic total occlusions. Catheter Cardiovasc Interv 2017; 92:488-496. [DOI: 10.1002/ccd.27390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - David Verhaert
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Bruno Pereira
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | - Peter Frambach
- Department of Cardiology; Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle; Luxembourg Luxembourg
| | | | - Emanuele Barbato
- Department of Cardiology; Onze-Lieve-Vrouw-Ziekenhuis; Aalst Belgium
- Department of Advanced Biomedical Medicine; University of Naples Federico II; Naples Italy
| | - Endry Willems
- Department of Radiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Mathias Vrolix
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
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27
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Abizaid A, Vrolix M, Costa JR, Chamie D, Abizaid A, Castro J, Bhat V, Morrison L, Toyloy S, Verheye S. TCT-330 Multi-Center Evaluation of a Novel 120 μm Novolimus-Eluting, Fully Bioresorbable Coronary Scaffold: First Report of 6-month Imaging and 12-Month Clinical Results. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Verheye S, Vrolix M, Kumsars I, Erglis A, Sondore D, Agostoni P, Cornelis K, Janssens L, Maeng M, Slagboom T, Amoroso G, Jensen LO, Granada JF, Stella P. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis): Angiographic Results and 1-Year Clinical Outcomes. JACC Cardiovasc Interv 2017; 10:2029-2037. [PMID: 28964764 DOI: 10.1016/j.jcin.2017.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this first-in-human study was to assess the safety and effectiveness of the Virtue sirolimus-eluting balloon in a cohort of patients with in-stent restenosis (ISR). BACKGROUND Angioplasty balloons coated with the cytotoxic drug paclitaxel have been widely used for ISR treatment. The Virtue angioplasty balloon (Caliber Therapeutics, New Hope, Pennsylvania) delivers sirolimus in a nanoencapsulated liquid formulation. This clinical trial is the first to examine a sirolimus-eluting balloon for ISR. METHODS In this prospective, single-arm feasibility study at 9 European centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. RESULTS Procedural success in the intention-to-treat population was 100%. The primary safety endpoint was target lesion failure (TLF) (cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization) assessed at 30 days (0%, n = 50). The primary performance endpoint was in-segment late lumen loss (LLL) at 6 months (0.31 ± 0.52 mm; n = 47). Secondary 6-month endpoints include binary restenosis (19.1%), diameter stenosis (30.3 ± 19.9%), and major adverse cardiac events (MACE) (10.2%, n = 49). In the 36-patient per-protocol population (excluding major protocol violations and previously stented ISR), LLL was 0.12 ± 0.33 mm at 6 months. Clinical outcomes at 1 year for the intention-to-treat group were 12.2% TLF and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. CONCLUSIONS This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes that warrant further evaluation in dedicated randomized studies.
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Affiliation(s)
- Stefan Verheye
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium.
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Indulis Kumsars
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Andrejs Erglis
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Dace Sondore
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Luc Janssens
- Department of Cardiology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ton Slagboom
- Department of Cardiology, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Giovanni Amoroso
- Department of Cardiology, OLVG Amsterdam, Amsterdam, the Netherlands
| | | | - Juan F Granada
- Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, New York
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Maeremans J, Verhaert D, Pereira B, Frambach P, Van Mieghem C, Barbato E, Willems E, Vrolix M, Dens J. P497One-year clinical and computed tomography follow-up after implantation of bioresorbable vascular scaffolds in patients with coronary chronic total occlusions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Lempereur M, Magne J, Cornelis K, Hanet C, Taeymans Y, Vrolix M, Legrand V. Impact of gender difference in hospital outcomes following percutaneous coronary intervention. Results of the Belgian Working Group on Interventional Cardiology (BWGIC) registry. EUROINTERVENTION 2017; 12:e216-23. [PMID: 25539416 DOI: 10.4244/eijy14m12_11] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To determine whether there are gender-based differences in in-hospital outcomes among patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS We studied a large cohort using clinical data from a registry of 130,985 PCI procedures in Belgium, from January 2006 to February 2011. Compared to males, females were significantly older (70.3 vs. 64.8 years), and were more frequently diabetic or hypertensive. Men smoked more and more frequently had previous myocardial infarction (MI), previous PCI or previous coronary artery bypass graft (CABG) surgery. Coronary artery disease (CAD) was less severe in women, and PCI to the left anterior descending artery was more common in female patients. Unadjusted in-hospital mortality rates were higher in females versus males (2.5% for women and 1.6% for men, p<0.0001). After multivariable analysis, female gender remained an independent predictor of mortality (odds ratio 1.35, 95% CI: 1.22-1.49, p<0.0001). CONCLUSIONS Gender-based differences in hospital mortality rates after PCI were observed in this large registry. Female sex remained an independent predictor of mortality after multivariable adjustment.
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Beauloye C, Vrolix M, Claeys MJ, Borne PVD, Vandendriessche E, Werf FVD. Pre-hospital management of acute coronary syndrome patients in Belgium and Luxembourg and other Western European countries: a subset analysis of results from the observational, longitudinal cohort study EPICOR. Acta Cardiol 2017. [DOI: 10.1080/ac.71.1.3132093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christophe Beauloye
- Division of Cardiology, Cliniques universitaires Saint Luc, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), UCL, Brussels, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Philippe Van De Borne
- Department of Cardiology, Université Libre de Bruxelles-Erasme Hospital, Brussels, Belgium
| | | | - Frans Van De Werf
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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32
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Boonen L, Verbrugge FH, Nijs P, Noyens P, De Vusser P, Verhaert D, VanLierde J, Vrolix M, Dupont M, Mullens W. Subclinical volume overload in stable outpatients with chronic heart failure. Acta Cardiol 2017. [DOI: 10.1080/ac.71.3.3152090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Levinia Boonen
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Both authors contributed equally to the manuscript
| | - Frederik Hendrik Verbrugge
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Both authors contributed equally to the manuscript
| | - Petra Nijs
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Patrick Noyens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Philip De Vusser
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Verhaert
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johan VanLierde
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Legrand D, Barbato E, Chenu P, Magne J, Vrolix M, Wijns W, Legrand V. The STIB score: a simple clinical test to predict clopidogrel resistance. Acta Cardiol 2017. [DOI: 10.1080/ac.70.5.3110511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sinnaeve PR, Desmet W, Descamps O, Gevaert S, De Backer G, Kolh P, Vrolix M, Van De Borne P, De Meester A, Claeys MJ, Beauloye C. One-year and longer dual antiplatelet therapy after an acute coronary syndrome: a Belgian position paper. Acta Cardiol 2017; 72:19-27. [PMID: 28597739 DOI: 10.1080/00015385.2017.1281563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute coronary syndrome patients receive DAPT up to one year after their initial event. Exceptions to the guideline-recommended one-year rule, however, are not uncommon. The reasoning behind shorter treatments, such as unacceptable bleeding risk or urgent surgery, should be well documented in the patient's charts and discharge letter. Based on recent evidence, patients at high risk for repetitive events should continue on low-dose ticagrelor without a significant interruption at one year and indefinitely in the absence of excess bleeding risk. As there is currently no reimbursement, policy makers and insurers should be made aware of the continuing risk and unmet clinical need in this patient population. Nevertheless, many unsolved questions need to be answered, both through additional analyses from recent trials such as PEGASUS-TIMI 54 or DAPT, as well as new carefully designed clinical studies.
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Affiliation(s)
- Peter R. Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Descamps
- Department of Internal Medicine and Department of Cardiology, Centre Hospitalier Jolimont, Haine St. Paul, Belgium
- Department of Cardiovascular Diseases, Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Gent, Belgium
| | - Guy De Backer
- Department of Public Health, Ghent University, Gent, Belgium
| | - Philippe Kolh
- Department of Cardiovascular Surgery, University Hospital (CHU, ULg) of Liège, Liège, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Philippe Van De Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine De Meester
- Department of Internal Medicine and Department of Cardiology, Centre Hospitalier Jolimont, Haine St. Paul, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Christophe Beauloye
- Department of Cardiovascular Diseases, Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium
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van Geuns RJM, Yetgin T, La Manna A, Tamburino C, Souteyrand G, Motreff P, Koch KT, Vrolix M, IJsselmuiden A, Amoroso G, Berland J, Montalescot G, Teiger E, Christiansen EH, Spaargaren R, Wijns W. STENTYS Self-Apposing sirolimus-eluting stent in ST-segment elevation myocardial infarction: results from the randomised APPOSITION IV trial. EUROINTERVENTION 2016; 11:e1267-74. [PMID: 26865444 DOI: 10.4244/eijv11i11a248] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We sought to investigate the impact of the self-apposing, sirolimus-eluting STENTYS stent on midterm and long-term stent apposition and strut coverage compared with a zotarolimus-eluting balloon-expandable stent in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS In the APPOSITION IV trial, 152 STEMI patients were randomised (3:2) to the self-apposing, sirolimus-eluting STENTYS stent or a commercially available zotarolimus-eluting balloon-expandable stent at 12 sites in five countries with angiographic follow-up and optical coherence tomography at four or nine months. At four months, a lower percentage of malapposed stent struts was observed in the STENTYS group (N=21; Nstruts=501) compared with controls (N=26; Nstruts=326; 0.07% vs. 1.16%; p=0.002) with significantly more covered struts, using a 20 µm cut-off (94.32% vs. 89.09%; p=0.003). At nine months, the primary endpoint (percentage malapposed stent struts) was similar in both groups (STENTYS, N=40; Nstruts=566; control, N=21; Nstruts=292), showing complete apposition (p=0.55) and near total (>96%) coverage (p=0.58). CONCLUSIONS In STEMI patients undergoing PPCI, the self-apposing, sirolimus-eluting STENTYS stent was equivalent to a conventional drug-eluting balloon-expandable stent with respect to late stent strut apposition and coverage at nine months. However, stent strut apposition and coverage at four months were significantly better in the STENTYS group.
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Bertrand PB, Vitel E, Mast TP, D'ascenzi F, Debusschere N, Dezutter T, Mortier P, De Santis G, Vrolix M, Heyde B, Claus P, Verdonck PR, Vandervoort PM, De Beule M, Pimor A, Bouzille G, Leclercq C, Donal E, Teske AJ, Walmsley J, Van Der Heijden JF, Van Es R, Prinzen F, Delhaas T, Van Veen T, Loh P, Doevendans P, Cramer MJ, Lumens J, Pisicchio A, Caselli S, Di Paolo FM, Spataro A, Pelliccia A. Young Investigator Award Session: Clinical Science429Patient-specific numerical mitral valve modelling in secondary mitral regurgitation: clinical validity of a promising technique430Importance of the measurement of right ventricular function when exercising patients with asymptomatic severe primary mitral regurgitation431Echocardiographic deformation imaging and computer simulation for electromechanical substrate characterization in arrhythmogenic right ventricular cardiomyopathy432The right ventricle of olympic athletes: characteristics and implications for the clinical evaluation. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew244] [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: 11/13/2022] Open
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Boonen L, Verbrugge FH, Nijst P, Noyens P, De Vusser P, Verhaert D, Van Lierde J, Vrolix M, Dupont M, Mullens W. Subclinical volume overload in stable outpatients with chronic heart failure. Acta Cardiol 2016; 71:299-307. [PMID: 27594125 DOI: 10.2143/ac.71.3.3152090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dubois C, Bennett J, Dens J, De Cock D, Desmet W, Belmans A, Ughi GJ, Sinnaeve P, Vrolix M, D’hooge J, Adriaenssens T. COmplex coronary Bifurcation lesions: RAndomized comparison of a strategy using a dedicated self-expanding biolimus-eluting stent versus a culotte strategy using everolimus-eluting stents: primary results of the COBRA trial. EUROINTERVENTION 2016; 11:1457-67. [DOI: 10.4244/eijy15m05_02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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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Hendrickx I, Bertrand PB, Vrolix M, Ferdinande B, Cruysberghs Y. Papillary fibro-elastoma as a rare cause of rate-dependent angina: importance of diastolic coronary perfusion. Eur Heart J Cardiovasc Imaging 2016; 17:632. [PMID: 26985075 DOI: 10.1093/ehjci/jew034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ief Hendrickx
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium
| | - Philippe B Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium
| | - Yves Cruysberghs
- Department of Cardiology, Ziekenhuis Maas en Kempen, B-3680 Maaseik, Belgium
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Beauloye C, Vrolix M, Claeys MJ, van de Borne P, Vandendriessche E, Van De Werf F. Pre-hospital management of acute coronary syndrome patients in Belgium and Luxembourg and other Western European countries. Acta Cardiol 2016; 71:15-24. [PMID: 26853249 DOI: 10.2143/ac.71.1.3132093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This sub-analysis of the EPICOR study describes pre-hospital care (PHC) patterns in Belgium, Luxembourg (Belux) and Western European (WEU) countries (Finland, Norway, Denmark, the Netherlands, UK, Belgium, Luxembourg, Spain, France, Italy, Greece and Germany. METHODS AND RESULTS EPICOR (NCT01171404) is multinational, observational study comprising patients with acute coronary syndrome hospitalized within 24h of symptoms onset, diagnosed with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or unstable angina (UA). Of the 325 WEU centres, 37 were in Belgium and 1 in Luxembourg. PHC was defined as pre-hospital ECG and/or pre-hospital medication (PHM). 504 Belux and 6,119 WEU patients were enrolled. Of the WEU patients 51.5% received PHC and 28.1% PHM, compared to 27.6% and 11.3% of the Belux patients. These differences were observed in both STEMI and UA/NSTEMI patients. In Belux, the most frequent PHM was acetylsalicylic acid (53 patients); only 1 patient received thrombolytics. The median time from symptoms onset to ECG was longer for Belux (2.8 h) than for WEU patients (2.4 h). PHC shortened this time by almost 1.5h. Belux patients with PHC had a shorter median time between symptoms onset and first medical attention (FMA) than WEU patients (1.0 vs 1.3 h). Only 34.7% of Belux patients with pre-hospital ECG and with time from FMA to ECG available had ECG within 10 minutes of FMA, as recommended by the European Society of Cardiology. CONCLUSIONS In Belux, diagnostic ECG is delayed compared to WEU, despite the short time to FMA. Few patients undergo ECG within the recommended period, indicating room for improvement.
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Nakatani S, Onuma Y, Ishibashi Y, Karanasos A, Regar E, Garcia-Garcia HM, Tamburino C, Fajadet J, Vrolix M, Witzenbichler B, Eeckhout E, Spaulding C, Reczuch K, La Manna A, Spaargaren R, Capodanno D, Van Langenhove G, Verheye S, Serruys PW, van Geuns RJ. Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II study. EUROINTERVENTION 2015; 11:885-94. [DOI: 10.4244/eijy15m11_01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Legrand D, Barbato E, Chenu P, Magne J, Vrolix M, Wijns W, Legrand V. The STIB score: a simple clinical test to predict clopidogrel resistance. Acta Cardiol 2015; 70:516-21. [PMID: 26567810 DOI: 10.2143/ac.70.5.3110511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND High platelet reactivity (HPR) to clopidogrel is associated with an increased risk of ischaemic complications during and after coronary interventions and concerns up to 50% of patients undergoing PCI. AIM OF THE STUDY The aim of the study was to identify patients with HPR to clopidogrel using bedside clinical information obtained in the Stent Thrombosis In Belgium (STIB) trial. METHODS Data on platelet reactivity using the VerifyNow® point-of-care assay were obtained in 844 patients undergoing PCI for stable coronary artery disease 12 to 24 hours after a 600-mg loading dose of clopidogrel was given. Demographic, clinical and baseline routine biological tests were obtained and compared with P2Y12 reaction units (PRU). Patients with PRU>230 (HPR) were considered as non-responders to clopidogrel. RESULTS HPR was observed in 424/844 pts. Age, weight, body mass index (BMI), HPR to aspirin, diabetes, renal failure (MDRD<60 ml/min), haemoglobin (Hb), haematocrit, fibrinogen, glycaemia and glycated haemoglobin were associated with HPR to clopidogrel. In multivariate analysis, only Hb (OR: 0.77), BMI (OR: 1.06) and diabetes (OR: 1.62) emerged as independent risk factors. Hb<13.9 g/dl, BMI>28 kg/m2 and presence of diabetes were equally associated to predict HPR and can be added to derive a simple score to predict clopidogrel resistance. Although 38.5% of patients without a single clinical predictor still have HPR, 2/3 patients with 2 or 3 risk factors are resistant to clopidogrel. CONCLUSIONS STIB HPR score allows identification of patients with a high probability of resistance to clopidogrel based on diabetes, Hb<13.9 g/dl and BMI>28 kg/m2. This bedside clinical test could be useful for the identification of patients in whom another P2Y12 inhibitor should be recommended before and after PCI.
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Rusinaru D, Vrolix M, Verheye S, Chowdhary S, Schoors D, Di Mario C, Desmet W, Donohoe DJ, Ormiston JA, Knape C, Bezerra H, Lansky A, Wijns W. Bioabsorbable polymer-coated sirolimus-eluting stent implantation preserves coronary vasomotion: A DESSOLVE II trial sub-study. Catheter Cardiovasc Interv 2015; 86:1141-50. [DOI: 10.1002/ccd.25610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/15/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Dan Rusinaru
- Cardiovascular Research Center Aalst, OLV Clinic; Aalst Belgium
| | | | | | - Saqib Chowdhary
- South Manchester University Hospital; Manchester United Kingdom
| | | | - Carlo Di Mario
- NIHR Cardiovascular Research Unit; Royal Brompton Hospital & Imperial College; London United Kingdom
| | - Walter Desmet
- Department of Cardiovascular Diseases; UZ Leuven Belgium
| | | | | | | | | | | | - William Wijns
- Cardiovascular Research Center Aalst, OLV Clinic; Aalst Belgium
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Barbato E, Salinger-Martinovic S, Sagic D, Beleslin B, Vrolix M, Neskovic AN, Jagic N, Verheye S, Mehmedbegovic Z, Wijns W. A first-in-man clinical evaluation of Ultimaster, a new drug-eluting coronary stent system: CENTURY study. EUROINTERVENTION 2015; 11:541-548. [PMID: 25136883 DOI: 10.4244/eijy14m08-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIMS To report the six-month angiographic and two-year clinical outcome data from the first-in-man study with the Ultimaster DES, a thin-strut cobalt-chromium sirolimus-eluting stent (SES) with an innovative abluminal-gradient-coated bioresorbable polymer. METHODS AND RESULTS CENTURY is a multicentre, single-arm, prospective study that enrolled 105 patients (113 lesions) with coronary artery disease. All patients were scheduled to have an angiographic follow-up at six months, while 45 and 20 patients respectively had IVUS and OCT assessments. The primary endpoint was six-month in-stent late lumen loss. Secondary endpoints included clinical, IVUS and OCT outcomes. Clinical follow-up is available up to two years and will continue up to five years. Procedural success was 97.1% and device success was 100%. Angiographic late loss at six months was 0.04±0.35 mm, also reflected in a low binary restenosis rate of 0.9% and confirmed by IVUS-assessed neointimal volume obstruction of 1.02±1.62%. The mean strut coverage assessed by OCT was 96.2% with 1.66±4.02 malapposed stent struts. There were no deaths in the study, three (2.9%) periprocedural and one (0.9%) spontaneous myocardial infarction, not related to the target vessel. At one and two years, the target lesion failure rate was 3.8% and 5.7%, while the TLR rate was 1.9% and 2.8%, respectively. There was one acute definite stent thrombosis. CONCLUSIONS The Ultimaster™ novel bioresorbable polymer sirolimus-eluting stent demonstrated good performance, including high procedural success and strong suppression of neointimal proliferation at six months. Good safety and effectiveness were shown up to two years in the studied population.
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Barbato E, Salinger-Martinovic S, Sagic D, Beleslin B, Vrolix M, Neskovic AN, Jagic N, Verheye S, Mehmedbegovic Z, Wijns W. A first-in-man clinical evaluation of Ultimaster, a new drug-eluting coronary stent system: CENTURY study. EUROINTERVENTION 2015; 11:541-8. [DOI: 10.4244/eijy14m08_06] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dewilde WJM, Janssen PW, Kelder JC, Verheugt FW, De Smet BJ, Adriaenssens T, Vrolix M, Brueren GB, Van Mieghem C, Cornelis K, Vos J, Breet NJ, ten Berg JM. Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial. EUROINTERVENTION 2015; 11:381-90. [DOI: 10.4244/eijy14m06_07] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wijns W, Vrolix M, Verheye S, Schoors D, Slagboom T, Gosselink M, Benit E, Donohoe D, Knape C, Attizzani GF, Lansky AJ, Ormiston J. Randomised study of a bioabsorbable polymer-coated sirolimus-eluting stent: results of the DESSOLVE II trial. EUROINTERVENTION 2015; 10:1383-90. [DOI: 10.4244/eijy14m05_03] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kellens S, Verbrugge FH, Vanmechelen M, Grieten L, Van Lierde J, Dens J, Vrolix M, Vandervoort P. Point-of-care heart-type fatty acid binding protein versus high-sensitivity troponin T testing in emergency patients at high risk for acute coronary syndrome. Eur Heart J Acute Cardiovasc Care 2015; 5:177-84. [PMID: 25666938 DOI: 10.1177/2048872615570221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin testing is used to detect myocardial damage in patients with acute chest pain. Heart-type fatty acid binding protein (H-FABP) may be an alternative, available as point-of-care test. METHODS Patients (n=203) referred by general practitioners for suspected acute coronary syndrome or presenting with typical chest pain and one major cardiovascular risk factor at the emergency department were prospectively included in a single-centre cohort study. High-sensitivity cardiac troponin T (hs-TnT) and point-of-care H-FABP testing were concomitantly performed at admission and after 6h. RESULTS Maximal hs-TnT levels above the 99th percentile were observed in 152 patients (75%) with 127 (63%) fulfilling criteria for myocardial infarction. Upon admission, hs-TnT and H-FABP were associated with an area under the curve (95% CI) of 0.83 (0.77-0.89) and 0.79 (0.73-0.85), respectively, to predict myocardial infarction, which increased to 0.93 (0.90-0.97) and 0.88 (0.84-0.93), respectively, after 6h. The diagnostic accuracy for non-ST-segment elevation myocardial infarction was somewhat lower with an area under the curve (95% CI) of 0.80 (0.72-0.87), 0.90 (0.84-0.96), 0.73 (0.64-0.81) and 0.77 (0.67-0.86), respectively. When assessment was performed within 3h of chest pain onset, diagnostic accuracy of H-FABP versus hs-TnT was similar. Each standard deviation increase in admission H-FABP was associated with a 68% relative risk increase of all-cause mortality (p-value=0.027) during 666 ± 155 days of follow-up. CONCLUSIONS Point-of-care H-FABP testing has lower diagnostic accuracy compared with hs-TnT assessment in patients with high pre-test acute coronary syndrome probability, but might be of interest when assessment is possible early after chest pain onset.
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Affiliation(s)
| | - Frederik H Verbrugge
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Lars Grieten
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Johan Van Lierde
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Pieter Vandervoort
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Verheye S, Jolicœur EM, Behan MW, Pettersson T, Sainsbury P, Hill J, Vrolix M, Agostoni P, Engstrom T, Labinaz M, de Silva R, Schwartz M, Meyten N, Uren NG, Doucet S, Tanguay JF, Lindsay S, Henry TD, White CJ, Edelman ER, Banai S. Efficacy of a device to narrow the coronary sinus in refractory angina. N Engl J Med 2015; 372:519-27. [PMID: 25651246 PMCID: PMC6647842 DOI: 10.1056/nejmoa1402556] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure in the coronary sinus, thus redistributing blood into ischemic myocardium. METHODS We randomly assigned 104 patients with Canadian Cardiovascular Society (CCS) class III or IV angina (on a scale from I to IV, with higher classes indicating greater limitations on physical activity owing to angina) and myocardial ischemia, who were not candidates for revascularization, to implantation of the device (treatment group) or to a sham procedure (control group). The primary end point was the proportion of patients with an improvement of at least two CCS angina classes at 6 months. RESULTS A total of 35% of the patients in the treatment group (18 of 52 patients), as compared with 15% of those in the control group (8 of 52), had an improvement of at least two CCS angina classes at 6 months (P=0.02). The device was also associated with improvement of at least one CCS angina class in 71% of the patients in the treatment group (37 of 52 patients), as compared with 42% of those in the control group (22 of 52) (P=0.003). Quality of life as assessed with the use of the Seattle Angina Questionnaire was significantly improved in the treatment group, as compared with the control group (improvement on a 100-point scale, 17.6 vs. 7.6 points; P=0.03). There were no significant between-group differences in improvement in exercise time or in the mean change in the wall-motion index as assessed by means of dobutamine echocardiography. At 6 months, 1 patient in the treatment group had had a myocardial infarction; in the control group, 1 patient had died and 3 had had a myocardial infarction. CONCLUSIONS In this small clinical trial, implantation of the coronary-sinus reducing device was associated with significant improvement in symptoms and quality of life in patients with refractory angina who were not candidates for revascularization. (Funded by Neovasc; COSIRA ClinicalTrials.gov number, NCT01205893.).
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Affiliation(s)
- Stefan Verheye
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | | | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust. London, UK
| | | | - Nathalie Meyten
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | | | | | | | | | | | - Christopher J. White
- The John Ochsner Heart & Vascular Institute, Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, MIT, Cambridge, MA USA, and Cardiovascular Division Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Shmuel Banai
- Tel Aviv Medical Center, The Tel Aviv University Medical School, Tel Aviv, Israel
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Verheye S, Carrié D, Khattab A, Slagboom T, berland J, Horak J, Vrolix M, Smits PC, Legrand VM, Van Mieghem NM, Fajadet J, Schofer J, Stella PR. TCT-599 Final procedural, 30-day and 6-month angiographic, clinical and OCT outcomes from the DIRECT II Trial using the Svelte Integrated Delivery System with Enzymatic Bioabsorbable Sirolimus Coating. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.664] [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: 10/24/2022]
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