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Tesche C, Baquet M, Bauer MJ, Straube F, Hartl S, Leonard T, Jochheim D, Fink D, Brandt V, Baumann S, Schoepf UJ, Massberg S, Hoffmann E, Ebersberger U. Prognostic Utility of Coronary Computed Tomography Angiography-derived Plaque Information on Long-term Outcome in Patients With and Without Diabetes Mellitus. J Thorac Imaging 2023; 38:179-185. [PMID: 34710893 DOI: 10.1097/rti.0000000000000626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the long-term prognostic value of coronary computed tomography angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus. MATERIALS AND METHODS In all, 64 patients with diabetes (63.3±10.1 y, 66% male) and suspected coronary artery disease who underwent cCTA were matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, and statin and antithrombotic therapy. MACE were recorded. cCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated using multivariable regression analysis and concordance indices. RESULTS After a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%). In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared with nondiabetic patients (all P <0.05). The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR=1.20, P <0.001), low-attenuation plaque (HR=3.47, P =0.05), and in nondiabetic patients: segment stenosis score (HR=1.92, P <0.001), Agatston score (HR=1.0009, P =0.04), and low-attenuation plaque (HR=4.15, P =0.04). A multivariable model showed a significantly improved C-index of 0.96 (95% confidence interval: 0.94-0.0.97) for MACE prediction, when compared with single measures alone. CONCLUSION Diabetes is associated with a significantly higher extent of coronary artery disease and plaque features, which have independent predictive values for MACE. cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond the assessment of obstructive stenosis on cCTA alone with subsequent impact on individualized treatment decision-making.
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Affiliation(s)
- Christian Tesche
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
- Department of Internal Medicine, Cardiology, St. Johannes-Hospital, Dortmund
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Moritz Baquet
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
| | - Maximilian J Bauer
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Florian Straube
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
| | - Stefan Hartl
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf
| | - Tyler Leonard
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - David Jochheim
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
| | - David Fink
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
| | - Verena Brandt
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Stefan Baumann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Steffen Massberg
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
| | - Ellen Hoffmann
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
| | - Ullrich Ebersberger
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen
- Kardiologie MVZ München-Nord, Munich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
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Mehilli J, Baquet M, Hochholzer W, Mayer K, Tesche C, Aradi D, Xu Y, Thienel M, Gschwendtner S, Zadrozny M, Jochheim D, Sibbing D, Schüpke S, Mansmann U, Hoffmann E, Kastrati A, Neumann FJ, Massberg S. Randomized Comparison of Intensified and Standard P2Y 12-Receptor-Inhibition Before Elective Percutaneous Coronary Intervention: The SASSICAIA Trial. Circ Cardiovasc Interv 2020; 13:e008649. [PMID: 32527192 DOI: 10.1161/circinterventions.119.008649] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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 Even among biomarker-negative patients undergoing elective percutaneous coronary intervention (PCI), periprocedural thrombotic and bleeding complications can lead to increased morbidity and mortality. Whether stronger platelet inhibition by an intensified oral loading strategy (ILS) before PCI impacts on outcomes among these patients in contemporary practice remains unclear. METHODS This multicenter, randomized, assessor-blinded trial tested the hypothesis that in elective PCI prasugrel 60 mg (ILS) is superior to standard loading strategy with clopidogrel 600 mg regarding a composite primary end point of all-cause death, any myocardial infarction, definite/probable stent thrombosis, stroke, or urgent vessel revascularization. After PCI, all patients were on clopidogrel 75 mg/day and aspirin. The trial was terminated prematurely because of slower-than-expected recruitment and funding discontinuation. RESULTS Of 781 patients included in the final analysis, 382 were assigned to ILS and 399 to standard loading strategy. At 30 days, the primary end point occurred in 66 patients (17.3%) assigned to ILS and 74 patients (18.6%) assigned to standard loading strategy (odds ratio, 0.92 [95% CI, 0.63-1.32]; P=0.64). Any myocardial infarction and Bleeding Academic Research Consortium ≥2 bleeding rates were similar among ILS and standard loading strategy groups 16.2% versus 17.5%, odds ratio, 0.91 (95% CI, 0.62-1.32), P=0.62 and 4.2% versus 4.8%, odds ratio 0.87 (95% CI, 0.44-1.73), P=0.70, respectively. CONCLUSIONS In biomarker-negative stable and unstable angina patients undergoing elective PCI, the trial did not find a conclusive difference in efficacy or safety. This observation should be interpreted in the context of wide CIs and premature termination of the trial. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02548611.
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Affiliation(s)
- Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Moritz Baquet
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Willibald Hochholzer
- Klinik für Kardiologie und Angiologie II, Universitäres Herzzentrum Freiburg, Bad Krozingen, Germany (W.H., F.-J.N.)
| | - Katharina Mayer
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (K.M., S.S., A.K.)
| | - Christian Tesche
- Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bogenhausen, Munich, Germany (C.T., E.H.)
| | - Daniel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary (D.A.)
| | - Yujun Xu
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, Munich, Germany (Y.X., U.M.)
| | - Manuela Thienel
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.)
| | - Sarah Gschwendtner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.)
| | - Magda Zadrozny
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.)
| | - David Jochheim
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Dirk Sibbing
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Stefanie Schüpke
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (K.M., S.S., A.K.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Ulrich Mansmann
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, Munich, Germany (Y.X., U.M.)
| | - Ellen Hoffmann
- Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bogenhausen, Munich, Germany (C.T., E.H.)
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (K.M., S.S., A.K.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäres Herzzentrum Freiburg, Bad Krozingen, Germany (W.H., F.-J.N.)
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany (J.M., M.B., M.T., S.G., M.Z., D.J., D.S., S.M.).,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, all in Munich, Germany (J.M., M.R., D.J., D.S., S.S., A.K., S.M.)
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Jochheim D, Deseive S, Gschwendtner S, Bischoff B, Jochheim S, Hausleiter S, Zadrozny M, Baquet M, Tesche C, Massberg S, Mehilli J, Hausleiter J. Impact of severe left ventricular outflow tract calcification on device failure and short-term mortality in patients undergoing TAVI. J Cardiovasc Comput Tomogr 2020; 14:36-41. [DOI: 10.1016/j.jcct.2019.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
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Karam N, Jochheim D, Zadrozny M, Fischer JM, Gschwender S, Grundmann D, Baquet M, Bauer A, Theiss H, Hagl C, Pichlmeier M, Massberg S, Mehilli J. P5584Causes of death within the first year after transcatheter aortic valve implantation: Lessons from EVERY-TAVI registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
According to current recommendations, transcatheter aortic valve implantation (TAVI) should only be performed among patients with a life expectancy of at least one year. However, many deaths occur within the first year after TAVI.
Purpose
To assess the causes of death within one year after TAVI.
Methods
Data was taken between November 2007 and December 2017 from the EVERY-TAVI registry. Patients who died during TAVI or experienced mechanical complications requiring surgery were excluded from the analysis. We assessed the causes of death over 3 periods post-TAVI: within the first 30 days, between 30 and 90 days, and between 90 and 365 days.
Results
Overall, 2389 patients underwent TAVI without mechanical complications. Among them, 320 (1.3%) died within one year. Age was the main cause of death, accounting for 73 deaths (22.8%), followed by heart failure (20.6%) and infections (18.7%). During the first month, cardiogenic shock was the main cause of death (25.4%), followed by infections (22.2%) and terminal heart failure (20.6%), while age was responsible of only one death (1.6%). During the two following months, heart failure was the main cause of death (33.3%), followed by infections (21.2%), and the percentage of deaths due to age increased to 18.2%. After 3 months, age was the main cause of death (31.4%), followed by infection (16.8%) and heart failure (16.2%).
Causes of death within one year of TAVI Cause of death All (n=320) <30 days (n=63) 30–90 days (n=66) >90 days (n=191) Older age, n (%) 73 (22.8) 1 (1.6) 12 (18.2) 60 (31.4) Terminal heart failure, n (%) 66 (20.6) 13 (20.6) 22 (33.3) 31 (16.2) Infection, n (%) 60 (18.7) 14 (22.2) 14 (21.2) 32 (16.8) Terminal renal failure, n (%) 26 (8.1) 4 (6.3) 5 (7.6) 17 (8.9) Cardiogenic shock, n (%) 26 (8.1) 16 (25.4) 4 (6.1) 6 (3.1) Malignancies, n (%) 18 (5.6) 0 (0.0) 2 (3.0) 16 (8.4) Sudden death, n (%) 17 (5.3) 6 (9.5) 2 (3.0) 9 (4.7) Stroke, n (%) 12 (3.7) 4 (6.3) 2 (3.0) 6 (3.1) Accident, n (%) 7 (2.2) 2 (3.2) 0 (0.0) 5 (2.6) Myocardial infarction, n (%) 7 (2.2) 2 (3.2) 2 (3.0) 3 (1.6) Non-cardiac surgery, n (%) 5 (1.6) 1 (1.6) 1 (1.5) 3 (1.6) Pulmonary embolism, n (%) 3 (0.9) 0 (0.0) 0 (0.0) 3 (1.6)
Conclusion
Cardiogenic shock is the main cause within the first month after TAVI, while older age is the main cause overall and after the initial months, highlighting the need to more carefully selection of patients undergoing TAVI.
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Affiliation(s)
- N Karam
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - D Jochheim
- University Hospital of Munich, Cardiology, Munich, Germany
| | - M Zadrozny
- University Hospital of Munich, Cardiology, Munich, Germany
| | - J M Fischer
- University Hospital of Munich, Cardiology, Munich, Germany
| | - S Gschwender
- University Hospital of Munich, Cardiology, Munich, Germany
| | - D Grundmann
- University Hospital of Munich, Cardiology, Munich, Germany
| | - M Baquet
- University Hospital of Munich, Cardiology, Munich, Germany
| | - A Bauer
- University Hospital of Munich, Cardiology, Munich, Germany
| | - H Theiss
- University Hospital of Munich, Cardiology, Munich, Germany
| | - C Hagl
- University Hospital of Munich, Cardiac surgery, Munich, Germany
| | - M Pichlmeier
- University Hospital of Munich, Cardiac surgery, Munich, Germany
| | - S Massberg
- University Hospital of Munich, Cardiology, Munich, Germany
| | - J Mehilli
- University Hospital of Munich, Cardiology, Munich, Germany
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Baquet M, Hoppmann P, Grundmann D, Schmidt W, Kufner S, Theiss HD, Brunner S, Wiebe J, Eickhoff M, Jochheim D, Byrne RA, Laugwitz KL, Schunkert H, Massberg S, Kastrati A, Mehilli J. Sex and long-term outcomes after implantation of the Absorb bioresorbable vascular scaffold for treatment of coronary artery disease. EUROINTERVENTION 2019; 15:615-622. [DOI: 10.4244/eij-d-18-00603] [Citation(s) in RCA: 7] [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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6
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Baquet M, Grundmann D, Schmidt W, Thienel M, Jochheim D, Tesche C, Theiss HD, Brunner S, Massberg S, Mehilli J. Hybrid-stenting with metallic and bioresorbable drug-eluting stents 2-year clinical outcomes in KUM ABSORB registry. Catheter Cardiovasc Interv 2019; 93:71-78. [PMID: 30232838 DOI: 10.1002/ccd.27832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/06/2018] [Accepted: 07/28/2018] [Indexed: 11/08/2022]
Abstract
AIM AND OBJECTIVE We sought to investigate and compare outcomes 2 years after Hybrid-stenting with bioresorbable vascular scaffolds (BVS) and contemporary metallic drug-eluting stents (DES) within the same coronary lesion versus BVS alone. METHODS Between 11/2012 and 7/2015 at our institution, 134 (33.2%) were treated with Hybrid-stenting for complex or long coronary lesions, 270 patients were treated by BVS alone. The primary outcome of interest was target lesion failure (TLF) at 2-years of follow-up. RESULTS Patients treated by Hybrid-stenting were more frequently men (80% vs. 70%, p = 0.04) had extensive multivessel disease (84% vs. 71%, p < 0.01) including more complex (89% vs. 52%, p < 0.01) and longer lesions (28.9 mm vs 16.4 ± mm, p < 0.01) resulting in longer treated segments (47.3 mm vs 21.5 mm, p < 0.01) and more residual in-segment stenosis (12.3% vs 8.5%, p < 0.01) compared to BVS alone patients. At 2 years, cumulative incidence of TLF was 9.7% of Hybrid-stenting patients and 11.5% of BVS alone patients (p = 0.62), myocardial infarction (3.0% vs 4.1%, p = 0.59) and mortality (1.5% vs 4.1%, p = 0.17), respectively. Target lesion revascularization occurred in 9 Hybrid-stenting patients (2 located in DES) and in 20 BVS alone patients, cumulative incidence 6.7% vs. 7.4% (p = 0.80). Chronic kidney disease and residual in-segment stenosis >30% were identified as independent predictors of TLF at 2-years. CONCLUSION Despite differences in clinical and angiographic profile, Hybrid-stenting performed similar to BVS alone at 2 years after percutaneous coronary intervention.
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Affiliation(s)
- Moritz Baquet
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - David Grundmann
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - Wolfgang Schmidt
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - Manuela Thienel
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - David Jochheim
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Christian Tesche
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - Hans Diogenes Theiss
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - Stefan Brunner
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwigs-Maximilian-University, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany.,Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
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7
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Jochheim D, Deseive S, Bischoff B, Zadrozny M, Hausleiter S, Baquet M, Tesche C, Theiss H, Hagl C, Massberg S, Mehilli J, Hausleiter J. Severe Left Ventricular Outflow Tract Calcification Is Associated With Poor Outcome in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2019; 12:207-208. [DOI: 10.1016/j.jcmg.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
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8
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Gross L, Jochheim D, Nitschke T, Baquet M, Orban M, Holdt L, Zadrozny M, Hagl C, Teupser D, Bauer A, Massberg S, Mehilli J, Sibbing D. Platelet Reactivity and Early Outcomes after Transfemoral Aortic Valve Implantation. Thromb Haemost 2018; 118:1832-1838. [PMID: 30235476 DOI: 10.1055/s-0038-1670658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Beyond thromboembolic events, peri-procedural bleeding remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). The majority of TAVI patients receive a dual anti-platelet treatment (DAPT) regimen. This analysis from the EVERY-TAVI register database aimed to analyse whether the level of on-treatment adenosine diphosphate-induced platelet reactivity predicts early outcomes at 30 days after TAVI. A total of 146 consecutive TAVI patients on DAPT who underwent platelet function testing with the Multiplate analyser were included here. Definition of bleeding events was done according to the Valve Academic Research Consortium-2 (VARC-2) classification. In our cohort, a status of low platelet reactivity (LPR, ≤ 18 units) was observed in 79 patients (54%), while high platelet reactivity (HPR, ≥ 46 units) was present in 18 patients (12%). At 30-day follow-up, the incidence of VARC-2 bleeds was 45.6% (n = 36) in LPR patients and 23.9% (n = 16) in patients without LPR (hazard ratio [HR] 2.10, 95% confidence interval [CI], 1.17-3.79; p = 0.01). In age-adjusted multivariate analysis, a status of LPR was independently associated with VARC-2 bleeding events (HRadj, 2.06, 95% CI, 1.14-3.71; p = 0.02). HPR was not associated with the 30-day risk of death, stroke, or myocardial infarction (p ≥ 0.43). In summary, presence of LPR was associated with bleeding events in patients undergoing TAVI while presence of HPR was not associated with ischaemic outcomes at 30 days. The value of platelet function testing for bleeding risk prediction and for a possible guidance of anti-thrombotic treatment in the elderly TAVI population warrants further investigation.
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Affiliation(s)
- Lisa Gross
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - David Jochheim
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tobias Nitschke
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Moritz Baquet
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Martin Orban
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Lesca Holdt
- Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Magda Zadrozny
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Christian Hagl
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.,Department of Cardiac Surgery, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Daniel Teupser
- Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Axel Bauer
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dirk Sibbing
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Jochheim D, Barbanti M, Capretti G, Zadrozny M, Baquet M, Fischer J, Todaro D, Stefanini GC, Massberg S, Chieffo A, Presbitero P, Colombo A, Tamburino C, Mehilli J. 2145Type of oral anticoagulants and outcomes after transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2145] [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)
- D Jochheim
- Ludwig-Maximilians University, Munich, Germany
| | | | - G Capretti
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - M Zadrozny
- Ludwig-Maximilians University, Munich, Germany
| | - M Baquet
- Ludwig-Maximilians University, Munich, Germany
| | - J Fischer
- Ludwig-Maximilians University, Munich, Germany
| | - D Todaro
- Ferrarotto Hospital, Catania, Italy
| | | | - S Massberg
- Ludwig-Maximilians University, Munich, Germany
| | - A Chieffo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - P Presbitero
- Clinical Institute Humanitas IRCCS, Rozzano, Italy
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | | | - J Mehilli
- Ludwig-Maximilians University, Munich, Germany
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10
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Jochheim D, Zadrozny M, Ricard I, Sadry TM, Theiss H, Baquet M, Schwarz F, Bauer A, Khandoga A, Sadoni S, Pichlmaier M, Hausleiter J, Hagl C, Massberg S, Mehilli J. Predictors of cerebrovascular events at mid-term after transcatheter aortic valve implantation - Results from EVERY-TAVI registry. Int J Cardiol 2018; 244:106-111. [PMID: 28784441 DOI: 10.1016/j.ijcard.2017.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinical relevant cerebrovascular events (CVE) following transcatheter aortic valve implantation (TAVI) still remain a devastating complication associated with mortality and severe impairments. Therefore, identification of particularly modifiable predictors of this complication is clinically relevant and an important step for planning preventive strategies. METHODS A total of 985 patients who underwent trans-femoral TAVI for aortic valve stenosis in our institution from February 2008 to January 2015 were considered. The influence of demographics, clinical and procedural data on the occurrence of CVE was assessed with a competing risk model with death as competing event. Clinical events were defined according to VARC-2 criteria. RESULTS At a median follow-up of 838days, 95% CI 807-892, 59 patients experienced any CVE (5.9%) and the overall cumulative mortality rate was 46.1%. CVEs mainly occur later than 30days after TAVI (47.5%), 88.1% of them were of ischemic origin and 52.5% were disabling events. Independent predictors of CVEs were age (hazard ratio 1.05; 95% CI 1.01 to 1.09), history of CVE (hazard ratio 2.54; 95% CI 1.39 to 4.63) and use of balloon post-dilation (hazard ratio 1.85; 95% CI 1.08 to 3.18). CONCLUSION In patients undergoing TAVI incidence of clinically relevant CVEs is frequent with half of the events occurring after the first 30days post-TAVI. Identification of balloon post-dilation as the only modifiable predictor of CVE risk at mid-term, urges its cautious performance after prosthesis implantation. CLINICALTRIALS. GOV IDENTIFIER NCT02289339.
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Affiliation(s)
- David Jochheim
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Magda Zadrozny
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Ingrid Ricard
- Institute of Medical Informatics, Biometry and Epidemiology, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Tobias Mir Sadry
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Hans Theiss
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Moritz Baquet
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Florian Schwarz
- Department of Radiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Axel Bauer
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Khandoga
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Maximilian Pichlmaier
- Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilian University, Germany
| | - Joerg Hausleiter
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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11
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Baquet M, Jochheim D, Mehilli J. Polymer-free drug-eluting stents for coronary artery disease. J Interv Cardiol 2018; 31:330-337. [DOI: 10.1111/joic.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
| | - David Jochheim
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
| | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
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12
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Tesche C, Vliegenthart R, Duguay TM, De Cecco CN, Albrecht MH, De Santis D, Langenbach MC, Varga-Szemes A, Jacobs BE, Jochheim D, Baquet M, Bayer RR, Litwin SE, Hoffmann E, Steinberg DH, Schoepf UJ. Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve for Therapeutic Decision Making. Am J Cardiol 2017; 120:2121-2127. [PMID: 29102036 DOI: 10.1016/j.amjcard.2017.08.034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022]
Abstract
This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. The therapeutic strategy (optimal medical therapy alone vs revascularization) and the appropriate revascularization procedure (percutaneous coronary intervention vs coronary artery bypass grafting) were selected using cCTA-CT-FFR. Thirty-six patients (49%) had a functionally significant CAD based on ICA-FFR. cCTA-CT-FFR correctly identified a functionally significant CAD and the need of revascularization in 35 of 36 patients (97%). When revascularization was deemed indicated, the same revascularization procedure (32 percutaneous coronary interventions and 3 coronary artery bypass grafting) was chosen in 35 of 35 patients (100%). Overall, identical management strategies were selected in 73 of the 74 patients (99%). cCTA-CT-FFR shows excellent performance to identify patients with and without the need for revascularization and to select the appropriate revascularization strategy. cCTA-CT-FFR as a noninvasive "one-stop shop" has the potential to change diagnostic workflows and to directly inform therapeutic decision making in patients with suspected CAD.
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Affiliation(s)
- Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Rozemarijn Vliegenthart
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; University Medical Center Groningen, Center for Medical Imaging, Department of Radiology, University of Groningen, Groningen, The Netherlands
| | - Taylor M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Domenico De Santis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza," Rome, Italy
| | - Marcel C Langenbach
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Brian E Jacobs
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - David Jochheim
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Moritz Baquet
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sheldon E Litwin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ellen Hoffmann
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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13
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Mehilli J, Achenbach S, Woehrle J, Baquet M, Riemer T, Muenzel T, Nef H, Naber C, Richardt G, Zahn R, Gori T, Neumann T, Kastner J, Schmermund A, Hamm C. Clinical restenosis and its predictors after implantation of everolimus-eluting bioresorbable vascular scaffolds: results from GABI-R. EUROINTERVENTION 2017. [DOI: 10.4244/eij-d-17-00291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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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14
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Baquet M, Nef H, Gori T, Latib A, Capodanno D, Di Mario C, Sabate M, Colombo A, Tamburino C, Mehilli J. Restenosis patterns after bioresorbable vascular scaffold implantation: Angiographic substudy of the GHOST-EU registry. Catheter Cardiovasc Interv 2017; 92:276-282. [DOI: 10.1002/ccd.27350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic, LMU; Munich Germany
- German Centre for Cardiovascular Research, partner site Munich Heart Alliance; Munich Germany
| | - Holger Nef
- Department of Cardiology; University of Giessen; Giessen Germany
| | - Tomasso Gori
- Department of Cardiology; University Medical Center; Mainz Germany
- German Centre for Cardiovascular Research, partner site Rhine Main; Mainz Germany
| | - Azeem Latib
- Centro Cuore and San Raffaele Hospitals; Milan Italy
| | | | | | - Manel Sabate
- Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona; Barcelona Spain
| | | | | | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic, LMU; Munich Germany
- German Centre for Cardiovascular Research, partner site Munich Heart Alliance; Munich Germany
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15
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Tesche C, Caruso D, De Cecco CN, Shuler DC, Rames JD, Albrecht MH, Duguay TM, Varga-Szemes A, Jochheim D, Baquet M, Bayer RR, Ebersberger U, Litwin SE, Chiaramida SA, Hoffmann E, Schoepf UJ. Coronary Computed Tomography Angiography-Derived Plaque Quantification in Patients With Acute Coronary Syndrome. Am J Cardiol 2017; 119:712-718. [PMID: 28024654 DOI: 10.1016/j.amjcard.2016.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
This study investigated the discriminatory value of quantitative atherosclerotic plaque markers derived from coronary computed tomography angiography (cCTA) in patients with first acute coronary syndrome (ACS) compared with patients with stable coronary artery disease (CAD). Forty patients (56.9 ± 9.3 years, 55% men) admitted with their first ACS and Framingham risk score-matched controls with stable CAD were retrospectively analyzed. All patients had undergone cCTA followed by invasive coronary angiography. Total plaque volume, calcified and noncalcified plaque volumes, plaque burden (in %), remodeling index, lesion length, presence of napkin-ring sign, segment involvement score, and segment stenosis score were derived from cCTA and compared between both groups on a per-lesion and per-patient level. Patients with ACS showed a significant higher number of obstructive CAD and higher values for segment stenosis score, segment involvement score, noncalcified plaque volume, lesion length, and remodeling index than the stable angina group (all p <0.05). On a per-lesion level, culprit lesions had significantly higher values for plaque burden, total plaque volume, noncalcified plaque volume, remodeling index, lesion length, and prevalence of napkin-ring sign in comparison to nonculprit lesions (all p <0.05). On receiver-operating characteristics (ROC) analysis, a stepwise model demonstrated incremental discriminatory power for identifying ACS both per-patient (area under the curve 0.92, p <0.0001) as well as per-lesion (area under the curve 0.88, p <0.0001). cCTA-derived culprit plaque markers show discriminatory value both on a per-patient and per-lesion level. A combination of markers added to the Framingham risk score yields the greatest discriminatory ability.
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16
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Baquet M, Brenner C, Wenzler M, Eickhoff M, David J, Brunner S, Theiss H, Massberg S, Guagliumi G, Mehilli J. Impact of Clinical Presentation on Early Vascular Healing After Bioresorbable Vascular Scaffold Implantation. J Interv Cardiol 2016; 30:16-23. [DOI: 10.1111/joic.12359] [Citation(s) in RCA: 5] [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: 11/28/2022] Open
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Christoph Brenner
- Department of Internal Medicine III; Medical University of Innsbruck; Innsbruck Austria
| | - Maximilian Wenzler
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Madeleine Eickhoff
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Jochheim David
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Stefan Brunner
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Hans Theiss
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Steffen Massberg
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
| | - Giulio Guagliumi
- Interventional Cardiology Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
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17
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Tesche C, De Cecco CN, Stubenrauch A, Jacobs BE, Varga-Szemes A, Litwin SE, Ball BD, Baquet M, Jochheim D, Ebersberger U, Bayer RR, Hoffmann E, Steinberg DH, Schoepf UJ. Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease. Radiol Med 2016; 122:113-120. [DOI: 10.1007/s11547-016-0707-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/31/2016] [Indexed: 12/01/2022]
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18
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Mehilli J, Jochheim D, Abdel-Wahab M, Rizas K, Theiss H, Spenkuch N, Zadrozny M, Baquet M, El-Mawardy M, Sato T, Lange P, Kuppatt C, Greif M, Hausleiter J, Bauer A, Schwarz F, Pichlmaier M, Hagl C, Richardt G, Massberg S. One-year outcomes with two suture-mediated closure devices to achieve access-site haemostasis following transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2016; 12:1298-1304. [DOI: 10.4244/eijv12i10a213] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Tesche C, De Cecco CN, Vliegenthart R, Duguay TM, Stubenrauch AC, Rosenberg RD, Varga-Szemes A, Bayer RR, Yang J, Ebersberger U, Baquet M, Jochheim D, Hoffmann E, Steinberg DH, Chiaramida SA, Schoepf UJ. Coronary CT angiography-derived quantitative markers for predicting in-stent restenosis. J Cardiovasc Comput Tomogr 2016; 10:377-83. [PMID: 27431607 DOI: 10.1016/j.jcct.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) performed prior to percutaneous coronary intervention (PCI) with stent placement for predicting in-stent restenosis (ISR) as defined by quantitative coronary angiography (QCA). MATERIALS AND METHODS We retrospectively analyzed the data of 74 patients (60 ± 12 years, 72% male) who had undergone dual-source coronary CTA within 3 months prior to a PCI procedure that included stent placement. Quantitative markers of the target vessel were derived from coronary CTA: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (PB in %), remodeling index (RI), and lesion length (LL). Marker performance for predicting ISR, as defined by QCA at follow-up, was assessed. RESULTS Twenty-one of 74 stented lesions showed ISR on follow-up (mean 616 ± 447 days). When comparing stent length and LL in patients with ISR, a trend towards less complete stent coverage of the target lesion was observed in cases with ISR (17/21 vs. 4/53 cases, p = 0.07). In multivariate analysis (corrected for dyslipidemia), the following markers showed predictive value for ISR (odds ratio [OR]): NCPV (OR 1.08, p = 0.045), LL (OR 1.38, p = 0.0024), and RI (OR 1.13, p = 0.0019). Sensitivity and specificity for ISR were: NCPV 65% and 80%, LL 74% and 74%, and RI 71% and 78%. At receiver-operating characteristics analysis, NCPV (0.72, p = 0.001), LL (0.77, p < 0.0001), and RI (0.79, p < 0.0001) showed discriminatory power for predicting ISR. A combination of these markers showed incremental predictive value (AUC 0.89, p < 0.0001) with sensitivity and specificity of 90% and 84%, respectively. CONCLUSION Coronary CTA-derived NCPV, LL, and RI portend predictive value for ISR with incremental predictive value when combining these parameters.
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Affiliation(s)
- Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Rozemarijn Vliegenthart
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Taylor M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew C Stubenrauch
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Russell D Rosenberg
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Junjie Yang
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China
| | - Ullrich Ebersberger
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Moritz Baquet
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - David Jochheim
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Salvatore A Chiaramida
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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20
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Tesche C, De Cecco CN, Caruso D, Baumann S, Renker M, Mangold S, Dyer KT, Varga-Szemes A, Baquet M, Jochheim D, Ebersberger U, Bayer RR, Hoffmann E, Steinberg DH, Schoepf UJ. Coronary CT angiography derived morphological and functional quantitative plaque markers correlated with invasive fractional flow reserve for detecting hemodynamically significant stenosis. J Cardiovasc Comput Tomogr 2016; 10:199-206. [PMID: 26993434 DOI: 10.1016/j.jcct.2016.03.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/26/2016] [Accepted: 03/05/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Compare morphological and functional coronary plaque markers derived from coronary CT angiography (CCTA) for their ability to detect lesion-specific ischemia. MATERIALS AND METHODS Data of patients who had undergone both dual-source CCTA and invasive fractional flow reserve (FFR) measurement within 3 months were retrospectively analyzed. Various quantitative stenosis markers were derived from CCTA: Corrected coronary opacification (CCO), transluminal attenuation gradient (TAG), remodeling index (RI), computational FFR (cFFR), lesion length (LL), vessel volume (VV), total plaque volume (TPV), and calcified and non-calcified plaque volume (CPV and NCPV). Discriminatory power of these markers for flow-limiting versus non-significant coronary stenosis was assessed against invasive FFR as the reference standard. RESULTS The cohort included 37 patients (61 ± 12 years, 68% male). Among 37 lesions, 11 were hemodynamically significant by FFR. On a per-lesion level, sensitivity and specificity of TPV, CPV, and NCPV for hemodynamically significant stenosis detection were 88% and 74%, 67% and 53%, and 92% and 81%, respectively. For CCO, TAG, RI, and cFFR these were 64% and 86%, 35% and 56%, 82% and 54%, and 100% and 90%, respectively. At ROC analysis, only TPV (0.78, p = 0.013), NCPV (0.79, p = 0.009), cFFR (0.85, p = 0.003), and CCO (0.82, p = 0.0003) showed discriminatory power for detecting hemodynamically significant stenosis. CONCLUSION TPV, NCPV, CCO, and cFFR derived from CCTA can aid detecting hemodynamically significant coronary lesions with cFFR showing the greatest discriminatory ability.
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Affiliation(s)
- Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Stefan Baumann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Internal Medicine I, Cardiology/Angiology, Giessen University, Giessen, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tuebingen, Tuebingen, Germany
| | - Kevin T Dyer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Moritz Baquet
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - David Jochheim
- Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Ullrich Ebersberger
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Richard R Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ellen Hoffmann
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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21
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Gross L, Sibbing D, Eickhoff M, Baquet M, Orban M, Krieg A, Grujic K, Theiss HD, Brunner S, Teupser D, Holdt L, Massberg S, Mehilli J. Impact of the bioresorbable vascular scaffold surface area on on-treatment platelet reactivity. Platelets 2016; 27:446-51. [DOI: 10.3109/09537104.2016.1143918] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lisa Gross
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Dirk Sibbing
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Madeleine Eickhoff
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Moritz Baquet
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Orban
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Krieg
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Katarina Grujic
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hans D. Theiss
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Brunner
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel Teupser
- Department of Laboratory Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Lesca Holdt
- Department of Laboratory Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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22
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Jochheim D, Khandoga A, Bauer A, Baquet M, Theiss H, Schenzle J, Hausleiter J, Massberg S, Mehilli J. Transseptal Transcatheter Implantation of a Third-Generation Balloon-Expandable Valve in Degenerated Mitral Bioprosthesis. JACC Cardiovasc Interv 2015; 8:e241-3. [PMID: 26718526 DOI: 10.1016/j.jcin.2015.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- David Jochheim
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany.
| | - Alexander Khandoga
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany
| | - Axel Bauer
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany
| | - Moritz Baquet
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany
| | - Hans Theiss
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany
| | - Jan Schenzle
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany
| | - Joerg Hausleiter
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung E.V., Munich, Germany
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23
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Braun D, Baquet M, Massberg S, Mehilli J, Hausleiter J. Collapse of a Bioresorbable Novolimus-Eluting Coronary Scaffold. JACC Cardiovasc Interv 2015; 9:e13-e14. [PMID: 26685077 DOI: 10.1016/j.jcin.2015.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany.
| | - Moritz Baquet
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany
| | - Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany
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24
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Jochheim D, Zadrozny M, Theiss H, Baquet M, Maimer-Rodrigues F, Bauer A, Lange P, Greif M, Kupatt C, Hausleiter J, Hagl C, Massberg S, Mehilli J. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2015; 11:214-20. [DOI: 10.4244/eijv11i2a40] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Gross L, Sibbing D, Eickhoff M, Baquet M, Orban M, Grujic K, Krieg A, Theiss H, Brunner S, Teupser D, Holdt L, Massberg S, Mehilli J, Klinik M. IMPACT OF THE ABSORB BIORESORBABLE VASCULAR SCAFFOLD SURFACE AREA ON ON-TREATMENT PLATELET REACTIVITY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Jochheim D, Egger A, Theiss H, Baquet M, Greif M, Hausleiter J, Mehilli J. TCT-707 Impact of Area Cover Index on the Incidence of Conduction Abnormalities after Implantation of Balloon-Expandable Aortic Prosthesis. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.779] [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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27
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Jochheim D, Zadrozny M, Theiss H, Baquet M, Greif M, Kupatt C, Hausleiter J, Massberg S, Mehilli J. TCT-712 Better Outcomes with Sapien 3 vsSapien XT balloon-expandable prosthesis in patients undergoing transfemoral aortic valve replacement. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.784] [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: 11/16/2022]
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