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Ayoub M, Corpataux N, Tajti P, Behnes M, Schupp T, Forner J, Akin I, Westermann D, Rudolph V, Mashayekhi K. A Novel Strategy for Emergency Treatment of Coronary Perforations by Placing a Drug-Eluting Stent before Sealing off the Leakage with a Covered Stent to Improve Long-Term Outcomes in Patients with Coronary Artery Perforations. J Pers Med 2023; 13:1542. [PMID: 38003857 PMCID: PMC10672714 DOI: 10.3390/jpm13111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
We aimed to investigate the safety, feasibility, and long-term results of drug-eluting stent implantation before covered stents for treating coronary artery perforation (CAP). Between 2015 and 2020, 12,733 patients undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. The primary endpoint was 1-year target lesion revascularization (TLR), whereas secondary endpoints included the rate of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death at 1 year. A total of 159 patients with CAP were identified during the study period, of whom 47.2% (n = 75) were treated with a covered stent (CS group) because of complex and/or severe CAP and 84 (52.8%) without (non-CS group). In the majority of patients, emergency drug-eluting stent placement before covered stent implantation was feasible (n = 69, 82%). There were no significant differences among patients treated with or without a covered stent in terms of primary or secondary clinical endpoints: a similar rate of TLR (18.67% vs. 21.43%, p = 0.6646), MACCE (25.33% vs. 22.62%, p = 0.6887), and 1-year mortality (12.00% vs. 11.90%, p = 0.9853) were identified comparing cases with covered stent implantation and without. In conclusion, our study implicates that the use of covered stents for sealing coronary perforation might not impact the 1-year clinical outcome if used properly. Moreover, the emergent use of drug-eluting stents before covered stent implantation in CAP is a safe and effective method to avoid target lesion revascularization in patients treated with covered stents.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Division of Cardiology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Péter Tajti
- Division of Interventional Cardiology, Gottsegen Gyorgy National Cardiovascular Center, 1096 Budapest, Hungary
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Jan Forner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
- Faculty of Medicine Göttingen, University of Göttingen, 37077 Göttingen, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Manheim, University of Heidelberg, 67059 Heidelberg, Germany
| | - Dirk Westermann
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine of the University Freiburg, 79106 Freiburg, Germany
- Clinic of Internal Medicine and Cardiology, Heart Center Lahr, 77933 Lahr, Germany
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Corpataux N, Koskinas K. [LDL-Lowering Drugs: What Are the Options In 2023?]. Praxis (Bern 1994) 2023; 112:562-565. [PMID: 37823812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Cardiovascular diseases are the leading causes of death worldwide, claiming an estimated 17.9 million lives each year. There is a dose-dependent relationship between the absolute extent of exposure of the vascular system to low-density lipoprotein cholesterol (LDL) and the risk of atherosclerotic cardiovascular disease. Meta-analyses confirm the beneficial effects of LDL reduction. In addition to lifestyle modifications, which remain the cornerstone of primary and secondary prevention, it is pharmacologically possible to lower plasma LDL levels. This article highlights where we stand with lipid-lowering drugs, more than 30 years after the first statins were used therapeutically.
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Affiliation(s)
- Noé Corpataux
- Klinik für Kardiologie, Universitätsspital Bern, Bern, Schweiz
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Ayoub M, Corpataux N, Behnes M, Schupp T, Forner J, Akin I, Neumann FJ, Westermann D, Rudolph V, Mashayekhi K. Safety and Efficiency of Rotational Atherectomy in Chronic Total Coronary Occlusion-One-Year Clinical Outcomes of an Observational Registry. J Clin Med 2023; 12:jcm12103510. [PMID: 37240617 DOI: 10.3390/jcm12103510] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The study sought to assess the procedural success of rotational atherectomy (RA) in coronary chronic total occlusion (CTO) and to investigate the in-hospital and one-year outcomes following RA. From 2015 to 2019, patients undergoing percutaneous coronary intervention for CTO (CTO PCI) were retrospectively included into the hospital database. The primary endpoint was procedural success. Secondary endpoints were in-hospital and one-year major adverse cardiovascular and cerebral event (MACCE) rates. During the study period of 5 years, 2.789 patients underwent CTO PCI. Patients treated with RA (n = 193, 6.92%) had a significantly higher procedural success (93.26% vs. 85.10%, p = 0.0002) compared to those treated without RA (n = 2.596, 93.08%). Despite a significantly higher rate of pericardiocentesis (3.11% vs. 0.50%, p = 0.0013) in the RA group, the in-hospital and one-year MACCE rate was similar in both groups (4.15% vs. 2.77%, p = 0.2612; 18.65% vs. 16.72%, p = 0.485). In conclusion, RA is associated with higher procedural success for CTO PCI, but has higher risks for pericardial tamponade than CTO PCI without the need for RA. Nevertheless, in-hospital and one-year MACCE rates did not differ in-between both groups.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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Gebhard C, Corpataux N, Gräni C, Haider A. Lipid-lowering therapy and the risk of dementia: lessons learned from two decades of controversy. Eur Heart J 2023:7075233. [PMID: 36896631 DOI: 10.1093/eurheartj/ehad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
- Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich , Rämistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich , Rämistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Samim D, Praz F, Cochard B, Brugger N, Ruberti A, Bartkowiak J, Corpataux N, Reineke D, Pilgrim T, Windecker S, Wenaweser PM, Wild MG. Natural history and mid-term prognosis of severe tricuspid regurgitation: A cohort study. Front Cardiovasc Med 2023; 9:1026230. [PMID: 36698931 PMCID: PMC9870052 DOI: 10.3389/fcvm.2022.1026230] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives The objective of this study was to characterize a population of patients with severe tricuspid regurgitation (TR) evaluated at a tertiary care center, assess mid-term clinical outcomes, and identify prognostic factors. Background The impact of TR on morbidity and mortality is increasingly recognized. Clinical characteristics and long-term outcomes of patients suffering from TR remain unclear. Methods This is a retrospective observational single-center study from a tertiary care hospital including patients with echocardiographic diagnosis of severe TR between January 2017 and December 2018. We used the Kaplan-Meier method to estimate survival for up to 4 years. After excluding patients with tricuspid valve (TV) intervention and surgery during follow-up, a multivariate analysis was performed to assess predictors of 2-year mortality using the Cox regression model. Results A total of 278 patients (mean age 74.9 ± 13.7 years, 47.8% female) with severe TR were included in the study. The majority (83.1%; n = 231) had secondary TR. Comorbidities such as atrial fibrillation (AFib) (68.0%; n = 189), severe renal failure (44.2%; n = 123), pulmonary hypertension (PHT) (80.9%; n = 225), and right ventricular (RV) dysfunction (59.7%; n = 166) were highly prevalent. More than half of patients with a cardiac implantable electronic device (CIED) (54.3%; n = 44) showed echocardiographic signs of lead-leaflet interaction causing or contributing to TR. The estimated 2- and 4-year all-cause mortality was 50 and 69%, respectively. Using multivariate analysis, age, severe renal failure, heart failure with reduced ejection fraction (HFrEF), and vena contracta width ≥14 mm were identified as predictors of 2-year mortality. Nine percent (n = 25) of the study cohort underwent transcatheter or surgical treatment for TR during follow-up. Conclusion Our study shows the high burden of morbidity and the dismal survival of patients with severe TR. It also highlights the extent of the therapeutic need, since the vast majority of patients were left untreated. Additionally, CIED RV lead-associated TR was prevalent suggesting a need for more attention in clinical routine and research.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Baptiste Cochard
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Andrea Ruberti
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Mirjam G. Wild
- Department of Cardiology, Bern University Hospital, Bern, Switzerland,Medizinische Klinik und Poliklinik I, LMU University Hospital, Munich, Germany,*Correspondence: Mirjam G. Wild,
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Corpataux N, Hochholzer W, Valina CM, Ferenc M, Löffelhardt N, Westermann D, Neumann FJ, Nührenberg TG. Serum lipoprotein(a) and 3-year outcomes in patients undergoing percutaneous coronary intervention. Curr Probl Cardiol 2022; 47:101362. [PMID: 36028053 DOI: 10.1016/j.cpcardiol.2022.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS We aimed at addressing the association between serum lipoprotein (a) levels and clinical outcomes of consecutive patients undergoing PCI. METHODS We used consecutive patients undergoing PCI at the Heart Center University of Freiburg, Bad Krozingen in Germany between January 2005 and November 2013. A total of 6679 patients [men (n = 5391) and women (n = 1288)] mean aged 67.5 (± 11.1) years were assessed at baseline and prospectively followed for 3 years. Lp(a) measurement were performed at hospital admission as a routine laboratory parameter. RESULTS Approximately 30% of PCI patients show an elevated Lp(a) value of more than 50mg/dL. In total, 736 Patients died during the follow-up, thereof 189 (11.3%) in the first quartile, 186 (10.7%) in the second quartile, 183 (11.5%) in the third quartile and 178 (10.7%) in the last quartile (p value 0.843 from LogRank test). The MACE rate showed consistent results with 409 (24.4%), 385 (22.1%), 395 (24.7%) and 419 (25.3%) in the different respective quartiles (p value 0.125 from LogRank test). CONCLUSION In this large non-selected cohort of patients undergoing PCI followed by moderate intensity statin therapy, higher Lp(a) levels were not associated with worse clinical outcomes during a follow-up of 3 years.
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Affiliation(s)
- Noé Corpataux
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Willibald Hochholzer
- Department of cardiology and intensive care medicine, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Christian Marc Valina
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | - Nikolaus Löffelhardt
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | - Dirk Westermann
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | - Thomas Georg Nührenberg
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
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Gragnano F, Spirito A, Corpataux N, Vaisnora L, Galea R, Gargiulo G, Siontis G, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Bär S, Ueki Y, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L, Valgimigli M. Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the ARC-HBR definition. EUROINTERVENTION 2021; 17:e898-e909. [PMID: 34105513 PMCID: PMC9725019 DOI: 10.4244/eij-d-21-00181] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The identification of bleeding risk factors in patients undergoing percutaneous coronary intervention (PCI) is essential to inform subsequent management. Whether clinical presentation per se affects bleeding risk after PCI remains unclear. AIMS We aimed to assess whether clinical presentation per se predisposes to bleeding in patients undergoing PCI and if the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria perform consistently in acute (ACS) and chronic (CCS) coronary syndrome patients. METHODS Consecutive patients undergoing PCI from the Bern PCI Registry were stratified by clinical presentation. Bleeding events at one year were compared in ACS versus CCS patients, and the originally defined ARC-HBR criteria were assessed. RESULTS Among 16,821 patients, 9,503 (56.5%) presented with ACS. At one year, BARC 3 or 5 bleeding occurred in 4.97% and 3.60% of patients with ACS and CCS, respectively. After adjustment, ACS remained associated with higher BARC 3 or 5 bleeding risk (adjusted HR 1.21, 95% CI: 1.01-1.43; p=0.034), owing to non-access site-related occurrences, which accrued mainly within the first 30 days after PCI. The ARC-HBR score had lower discrimination among ACS compared with CCS patients, and its performance slightly improved when ACS was computed as a minor criterion. CONCLUSIONS ACS presentation per se predicts one-year major bleeding risk after PCI. The ARC-HBR score discrimination appeared lower in ACS than CCS, and its overall performance improved numerically when ACS was computed as an additional minor risk criterion.
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Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Alessandro Spirito
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland,University Heart Center Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Lukas Vaisnora
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - George Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, and Azienda Ospedaliero Universitaria Policlinico “G. Rodolico – San Marco”, University of Catania, Catania, Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dik Heg
- Clinical Trials Unit (CTU) Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
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Brugger N, Kassar M, Siontis GCM, Widmer S, Okuno T, Winkel MG, Corpataux N, Gräni C, Büllesfeld L, Hunziker L, Pilgrim T, Windecker S, Praz F. Integrative echocardiographic assessment of patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2021; 98:1404-1412. [PMID: 34406713 DOI: 10.1002/ccd.29916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2021] [Accepted: 07/31/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate whether the integrative echocardiographic criteria used in the cardiovascular outcomes assessment of the mitraclip percutaneous therapy (COAPT) for heart failure patients with functional mitral regurgitation study predict outcomes after edge-to-edge trancatheter mitral valve repair (TMVr) for the treatment of secondary mitral regurgitation (SMR). BACKGROUND Two randomized controlled trials comparing TMVr to medical treatment reported conflicting findings. Differences in patient selection criteria may have contributed to these diverging results. METHODS Patients undergoing TMVr were stratified following the integrative COAPT echocardiographic criteria in noneligible and eligible patients who were further classified into three tiers according to effective regurgitant orifice (EROA) (Tier 1: EROA ≥ 0.3cm2 ; Tier 2: EROA 0.2cm2 and 0.29cm2 ; Tier 3: EROA<0.2cm2 ) combined with several other severity criteria. We assessed between group differences in all-cause mortality, successful SMR reduction, and symptom relief from baseline to 2-year follow-up. RESULTS Between March 2011 and March 2018, 138 patients (mean age 75 years) satisfying the inclusion criteria underwent TMVr for treatment of symptomatic SMR. The mean EROA area was 0.35 ± 0.17 mm2 . Ten patients (7%) died within 30 days, 29 (21%) within 12 months, and 41 (30%) within 2 years. After stratification according to the COAPT echocardiographic criteria that were fulfilled in 72% of the studied population, Tier 2 patients (45%), as well as noneligible patients (38%) had a higher mortality rate compared to those in Tier 1 (19%). CONCLUSIONS SMR patients stratified into tiers according to the COAPT integrative echocardiographic criteria have diverging prognostic and symptomatic benefit after edge-to-edge TMVr.
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Affiliation(s)
- Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Sonja Widmer
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam G Winkel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Lutz Büllesfeld
- Department of Internal Medicine and Cardiology, GFO Hospitals Bonn, Bonn, Germany
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Haberman D, Estévez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Nombela-Franco L, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Pascual I, Praz F, Sudarsky D, Kerner A, Ninios V, Gennari M, Beeri R, Perl L, Wasserstrum Y, Danenberg H, Poles L, George J, Caneiro-Queija B, Scianna S, Moaraf I, Schiavi D, Scardino C, Corpataux N, Echarte-Morales J, Chrissoheris M, Fernández-Peregrina E, Di Pasquale M, Regueiro A, Vergara-Uzcategui C, Iñiguez-Romo A, Fernández-Vázquez F, Dvir D, Maisano F, Taramasso M, Shuvy M. Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J 2021; 43:641-650. [PMID: 34463727 DOI: 10.1093/eurheartj/ehab496] [Citation(s) in RCA: 27] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. We aimed to report the international experience of patients with secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously. METHODS AND RESULTS Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centres in North America, Europe, and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class ≥3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18-0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5-19) vs. 19 days (10-40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55-9.07, P < 0.01). CONCLUSIONS Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients.
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Affiliation(s)
- Dan Haberman
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rodrigo Estévez-Loureiro
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | - Tomas Benito-Gonzalez
- Department of Cardiology, University Hospital of León, C/ ALTOS DE NAVA, S/N, León 24071, Spain
| | - Paolo Denti
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Carrer de Sant Quintí, 89, Barcelona 08041, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Xavier Freixa
- Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, 170, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain
| | - Pedro Villablanca
- Interventional Cardiology, The Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI, USA
| | - Lian Krivoshei
- Department of cardiology, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
| | - Konstantinos Spargias
- Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
| | - Andrew Czarnecki
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Hospital Road, ON M4N 3M5, Canada
| | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Av. Roma, Oviedo 33011, Spain
| | - Fabien Praz
- Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Doron Sudarsky
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Dov Hoz 0, Tiberias, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Efron St 1, Haifa 35254, Israel
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pilea, Thessaloniki 55535, Greece
| | - Marco Gennari
- IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Via Carlo Parea, 4, Milan 20138, Italy.,HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel
| | - Leor Perl
- Cardiology Department, Rabin Medical Center and The 'Sackler' Faculty of Medicine, Tel Aviv University, Zeev Jabotinsky St 39 Petah Tikva, 49100, Israel
| | - Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Haim Danenberg
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel
| | - Lion Poles
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob George
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Berenice Caneiro-Queija
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | - Salvatore Scianna
- HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Igal Moaraf
- Kantonsspital Baden, Department of Cardiology, Im Ergel 1, 5404 Baden, Switzerland
| | - Davide Schiavi
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, C/ Dr. Mallafrè Guasch, 4, Tarragona 43005, Spain
| | - Noé Corpataux
- Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Julio Echarte-Morales
- Department of Cardiology, University Hospital of León, C/ ALTOS DE NAVA, S/N, León 24071, Spain
| | - Michael Chrissoheris
- Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
| | | | - Mattia Di Pasquale
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Ander Regueiro
- Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, 170, Barcelona, Spain
| | - Carlos Vergara-Uzcategui
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain
| | - Andres Iñiguez-Romo
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | | | - Danny Dvir
- Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu'el Bait, POB 3235, Jerusalem 9103102, Israel
| | - Francesco Maisano
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel.,Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu'el Bait, POB 3235, Jerusalem 9103102, Israel
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10
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Okuno T, Corpataux N, Spano G, Gräni C, Heg D, Brugger N, Lanz J, Praz F, Stortecky S, Siontis GCM, Windecker S, Pilgrim T. True-severe stenosis in paradoxical low-flow low-gradient aortic stenosis: outcomes after transcatheter aortic valve replacement. Eur Heart J Qual Care Clin Outcomes 2021; 7:366-377. [PMID: 33576388 DOI: 10.1093/ehjqcco/qcab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
AIMS The ESC/EACTS guidelines propose criteria that determine the likelihood of true-severe aortic stenosis (AS). We aimed to investigate the impact of the guideline-based criteria of the likelihood of true-severe AS in patients with low-flow low-gradient (LFLG) AS with preserved ejection fraction (pEF) on outcomes following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS In a prospective TAVR registry, LFLG-AS patients with pEF were retrospectively categorized into high (criteria ≥6) and intermediate (criteria <6) likelihood of true-severe AS. Haemodynamic, functional, and clinical outcomes were compared with high-gradient AS patients with pEF. Among 632 eligible patients, 202 fulfilled diagnostic criteria for LFLG-AS. Significant haemodynamic improvement after TAVR was observed in LFLG-AS patients, irrespective of the likelihood. Although >70% of LFLG-AS patients had functional improvement, impaired functional status [New York Heart Association (NYHA III/IV)] persisted more frequently at 1 year in LFLG-AS than in high-gradient AS patients (7.8%), irrespective of the likelihood (high: 17.4%, P = 0.006; intermediate: 21.1%, P < 0.001). All-cause death at 1 year occurred in 6.6% of high-gradient AS patients, 10.9% of LFLG-AS patients with high likelihood [hazard ratio (HR)adj 1.43, 95% confidence interval (CI) 0.68-3.02], and in 7.2% of those with intermediate likelihood (HRadj 0.92, 95% CI 0.39-2.18). Among the criteria, only the absence of aortic valve area ≤0.8 cm2 emerged as an independent predictor of treatment futility, a combined endpoint of all-cause death or NYHA III/IV at 1 year (OR 2.70, 95% CI 1.14-6.25). CONCLUSION Patients with LFLG-AS with pEF had comparable survival but worse functional status at 1 year than high-gradient AS with pEF, irrespective of the likelihood of true-severe AS. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. NCT01368250.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Dik Heg
- CTU, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
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11
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Spirito A, Gragnano F, Corpataux N, Vaisnora L, Galea R, Svab S, Gargiulo G, Siontis GCM, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L, Valgimigli M. Sex-Based Differences in Bleeding Risk After Percutaneous Coronary Intervention and Implications for the Academic Research Consortium High Bleeding Risk Criteria. J Am Heart Assoc 2021; 10:e021965. [PMID: 34098740 PMCID: PMC8477884 DOI: 10.1161/jaha.121.021965] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Female sex was not included among the high bleeding risk (HBR) criteria by the Academic Research Consortium (ARC) as it remains unclear whether it constitutes an HBR condition after percutaneous coronary intervention. We investigated whether female sex associates with HBR and assessed the performance of ARC HBR criteria separately in women and men. Methods and Results Among all consecutive patients undergoing percutaneous coronary intervention between 2009 and 2018, bleeding occurrences up to 1 year were prospectively collected and centrally adjudicated. All but one of the originally defined ARC HBR criteria were assessed, and the ARC HBR score generated accordingly. Among 16 821 patients, 25.6% were women. Compared with men, women were older and had lower creatinine clearance and hemoglobin values. After adjustment, female sex was independently associated with access‐site (adjusted hazard ratio, 2.14; 95% CI, 1.22–3.74; P=0.008) but not with overall or non–access‐site 1‐year Bleeding Academic Research Consortium 3 or 5 bleeding. This association remained consistent when the femoral but not the radial approach was chosen. The ARC HBR score discrimination, using the original criteria, was lower among women than men (c‐index 0.644 versus 0.688; P=0.048), whereas a revised ARC HBR score, in which age, creatinine clearance, and hemoglobin were modeled as continuous rather than dichotomized variables, performed similarly in both sexes. Conclusions Female sex is an independent predictor for access‐site bleeding but not for overall bleeding events at 1 year after percutaneous coronary intervention. The ARC HBR framework shows an overall good performance in both sexes, yet is lower in women than men, attributable to dichotomization of age, creatinine clearance, and hemoglobin values, which are differently distributed between sexes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
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Affiliation(s)
| | - Felice Gragnano
- Department of Cardiology Bern University Hospital Bern Switzerland.,Division of Cardiology Department of Translational Medicine University of Campania "Luigi Vanvitelli Caserta Italy
| | - Noé Corpataux
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Lukas Vaisnora
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Roberto Galea
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefano Svab
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | | | - Fabien Praz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Jonas Lanz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | | | - Lukas Hunziker
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefan Stortecky
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Thomas Pilgrim
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Davide Capodanno
- Division of Cardiology Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania Catania Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine London United Kingdom
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Dik Heg
- Clinical Trial Unit Bern University of Bern Switzerland
| | | | - Lorenz Räber
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland.,Istituto Cardiocentro Ticino Ente Ospedaliero Cantonale Lugano Switzerland
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12
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Haberman D, Estévez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Nombela-Franco L, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Pascual I, Praz F, Sudarsky D, Kerner A, Ninios V, Gennari M, Beeri R, Perl L, Danenberg H, Poles L, Shimoni S, Goland S, Caneiro-Queija B, Scianna S, Moaraf I, Schiavi D, Scardino C, Corpataux N, Echarte-Morales J, Chrissoheris M, Fernández-Peregrina E, Di Pasquale M, Regueiro A, Vergara-Uzcategui C, Iñiguez-Romo A, Fernández-Vázquez F, Dvir D, Taramasso M, Shuvy M. Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction. J Clin Med 2021; 10:jcm10091819. [PMID: 33921996 PMCID: PMC8122348 DOI: 10.3390/jcm10091819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/28/2022] Open
Abstract
Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)-35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.
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Affiliation(s)
- Dan Haberman
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem 9190501, Israel; (L.P.); (S.S.); (S.G.)
- Correspondence:
| | - Rodrigo Estévez-Loureiro
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, 36321 Vigo, Spain; (R.E.-L.); (B.C.-Q.); (A.I.-R.)
| | - Tomas Benito-Gonzalez
- Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, 24071 Leon, Spain; (T.B.-G.); (J.E.-M.); (F.F.-V.)
| | - Paolo Denti
- Cardiovascular Surgery Department, San Raffaele University Hospital, 20132 Milan, Italy; (P.D.); (D.S.)
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, 08041 Barcelona, Spain; (D.A.); (E.F.-P.)
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (M.A.); (M.D.P.)
| | - Xavier Freixa
- Interventional Cardiology Unit, Hospital Clinic, 08036 Barcelona, Spain; (X.F.); (A.R.)
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (C.V.-U.)
| | - Pedro Villablanca
- Interventional Cardiology, The Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Lian Krivoshei
- Department of Cardiology, Kantonsspital Baden, 5404 Baden, Switzerland; (L.K.); (I.M.)
| | - Neil Fam
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Konstantinos Spargias
- Department of Transcatheter Heart Valves, HYGEIA Hospital, 15123 Athens, Greece; (K.S.); (M.C.)
| | - Andrew Czarnecki
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Fabien Praz
- Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (F.P.); (N.C.)
| | - Doron Sudarsky
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya 1520800, Israel;
| | - Arthur Kerner
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa 3109601, Israel;
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, 55535 Thessaloniki, Greece;
| | - Marco Gennari
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy;
- Heart Valve Clinic, University Hospital of Zurich, 8006 Zurich, Switzerland; (S.S.); (M.T.)
| | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (R.B.); (H.D.); (M.S.)
| | - Leor Perl
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Tel-Aviv 49100, Israel;
| | - Haim Danenberg
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (R.B.); (H.D.); (M.S.)
| | - Lion Poles
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem 9190501, Israel; (L.P.); (S.S.); (S.G.)
| | - Sara Shimoni
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem 9190501, Israel; (L.P.); (S.S.); (S.G.)
| | - Sorel Goland
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem 9190501, Israel; (L.P.); (S.S.); (S.G.)
| | - Berenice Caneiro-Queija
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, 36321 Vigo, Spain; (R.E.-L.); (B.C.-Q.); (A.I.-R.)
| | - Salvatore Scianna
- Heart Valve Clinic, University Hospital of Zurich, 8006 Zurich, Switzerland; (S.S.); (M.T.)
| | - Igal Moaraf
- Department of Cardiology, Kantonsspital Baden, 5404 Baden, Switzerland; (L.K.); (I.M.)
| | - Davide Schiavi
- Cardiovascular Surgery Department, San Raffaele University Hospital, 20132 Milan, Italy; (P.D.); (D.S.)
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain;
| | - Noé Corpataux
- Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (F.P.); (N.C.)
| | - Julio Echarte-Morales
- Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, 24071 Leon, Spain; (T.B.-G.); (J.E.-M.); (F.F.-V.)
| | - Michael Chrissoheris
- Department of Transcatheter Heart Valves, HYGEIA Hospital, 15123 Athens, Greece; (K.S.); (M.C.)
| | | | - Mattia Di Pasquale
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (M.A.); (M.D.P.)
| | - Ander Regueiro
- Interventional Cardiology Unit, Hospital Clinic, 08036 Barcelona, Spain; (X.F.); (A.R.)
| | - Carlos Vergara-Uzcategui
- Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (C.V.-U.)
| | - Andres Iñiguez-Romo
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, 36321 Vigo, Spain; (R.E.-L.); (B.C.-Q.); (A.I.-R.)
| | - Felipe Fernández-Vázquez
- Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, 24071 Leon, Spain; (T.B.-G.); (J.E.-M.); (F.F.-V.)
| | - Danny Dvir
- Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel;
| | - Maurizio Taramasso
- Heart Valve Clinic, University Hospital of Zurich, 8006 Zurich, Switzerland; (S.S.); (M.T.)
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (R.B.); (H.D.); (M.S.)
- Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel;
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13
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Galea R, De Marco F, Aminian A, Meneveau N, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Angelillis M, Brugger N, Spirito A, Corpataux N, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Windecker S, Räber L, Valgimigli M. Design and Rationale of the Swiss-Apero Randomized Clinical Trial: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure. J Cardiovasc Transl Res 2021; 14:930-940. [PMID: 33884564 DOI: 10.1007/s12265-020-10095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/09/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
Abstract
Residual or newly acquired leaks are routinely appraised after left atrial appendage closure (LAAC). The Watchman and the Amulet are the two most frequently used devices for LAAC but no randomized study has so far assessed their comparative leak rates after intervention. The "Comparison of Amplatzer Amulet vs Watchman devices in patients undergoing left atrial appendage closure" (Swiss-Apero, clinicaltrial.gov NCT03399851) is an academic-sponsored multicenter, randomized clinical trial comparing Amulet versus Watchman/FLX devices among patients undergoing a clinically indicated LAAC. The study is designed to assess the superiority of Amulet vs. Watchman/FLX in terms of leaks detected by cardiac computed tomography angiography (CCTA) at 45 days (primary endpoint) and 13 months (secondary endpoint) after intervention by an imaging Core Laboratory. The Swiss-Apero study is the first randomized clinical trial comparing Amulet and Watchman/FLX with respect to the prevalence of post-procedural leak as assessed with CCTA.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, 6900, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. .,Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.
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Corpataux N, Brugger N, Hunziker L, Reineke D, Windecker S, Vahanian A, Praz F. The role of transcatheter mitral valve leaflet approximation for the treatment of secondary mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2021; 18:261-272. [PMID: 33682563 DOI: 10.1080/17434440.2021.1899804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Secondary mitral regurgitation (SMR) is one of the most common valvulopathies and is associated with poor prognosis. Over the past years, medical management and mitral valve repair options have rapidly evolved offering new opportunities for a wide range of patients.Areas covered: We provide an up-to-date review of the value of medical and transcatheter mitral valve leaflet approximation for SMR integrating the results of most recent trials and putting their findings into clinical perspective.Expert opinion: Treatment of SMR requires a multidisciplinary approach with a long-term perspective. After optimization of medical treatment, transcatheter mitral valve repair should be considered in patients with persisting symptomatic severe SMR to improve symptoms and prognosis.
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Affiliation(s)
- Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Corpataux N, Brugger N, Winkel MG, Pilgrim T, Englberger L, Windecker S, Hunziker L, Praz F. Synergistic Effect of 2 Transcatheter Tricuspid Valve Treatment Modalities. JACC Cardiovasc Interv 2020; 14:e5-e7. [PMID: 33248983 DOI: 10.1016/j.jcin.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/03/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam G Winkel
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lars Englberger
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Corpataux N, Franke K, Kille A, Valina CM, Neumann FJ, Nührenberg T, Hochholzer W. Reticulated Platelets in Medicine: Current Evidence and Further Perspectives. J Clin Med 2020; 9:jcm9113737. [PMID: 33233836 PMCID: PMC7699936 DOI: 10.3390/jcm9113737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
Reticulated platelets (RPs) are young thrombocytes, newly released from the bone marrow. The identification and quantification of these cells remained difficult for decades due to a lack of standardized preanalytical and analytical methods. With the introduction of automated hematology analyzers in clinical routine, the determination of RPs, either as a total count or as a fraction, became more reliable, faster and more affordable. Currently, RPs are the focus of research in multiple clinical settings. In cardiovascular medicine, recent studies have focused on the relationship between RPs, coronary artery disease (CAD) and clinical outcomes, as well as the impact of RPs on the effects of antiplatelet therapy. Cohort studies showed increased levels of RPs in patients with acute coronary syndrome (ACS) or cardioembolic stroke. In patients with ACS, increased levels of RPs were also associated with an increased incidence of major ischemic cardiovascular events during follow-up. Further studies showed an association of levels of RPs with the antiplatelet response to less-potent P2Y12 inhibitors. In patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation, levels of RPs differed significantly depending on the achieved rhythm (sinus rhythm vs. recurrent atrial fibrillation). Levels of RPs appear to also be predictive for bleeding events in patients with various hematological diagnoses. Although no causal relationship has so far been proven, RP values have been associated with a large number of pathologies and clinical scenarios. This review summarizes the current evidence with regard to RPs and their potential diagnostic and prognostic value for noncardiovascular patients and for cardiovascular patients in particular. It describes further perspectives on how the testing of these cells might improve the treatment of cardiovascular patients.
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Ryffel C, Lanz J, Corpataux N, Reusser N, Stortecky S, Windecker S, Pilgrim T. Mortality, Stroke, and Hospitalization Associated With Deferred vs Expedited Aortic Valve Replacement in Patients Referred for Symptomatic Severe Aortic Stenosis During the COVID-19 Pandemic. JAMA Netw Open 2020; 3:e2020402. [PMID: 32997122 PMCID: PMC7527876 DOI: 10.1001/jamanetworkopen.2020.20402] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study evaluates the outcomes associated with deferred vs expedited aortic valve replacement in patients with severe aortic stenosis during the COVID-19 pandemic.
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Affiliation(s)
- Christoph Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Reusser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kallinikou Z, Arroyo D, Togni M, Lehman S, Corpataux N, Cook M, Müller O, Baeriswyl G, Stauffer JC, Goy JJ, Puricel SG, Cook S. Vascular response to everolimus- and biolimus-eluting coronary stents versus everolimus-eluting bioresorbable scaffolds--an optical coherence tomography substudy of the EVERBIO II trial. Swiss Med Wkly 2016; 146:w14274. [PMID: 26766027 DOI: 10.4414/smw.2016.14274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTIONS UNDER STUDY Head-to-head optical coherence tomography (OCT) data comparing metallic stents with bioresorbable vascular scaffolds (BVS) are lacking. This study assessed vascular healing at 9-month follow-up after implantation of everolimus- and biolimus-eluting stents (EES; BES) and everolimus-eluting BVS. METHODS OCT was performed in 74 patients enrolled in the EVERBIO II (NCT01711931) trial (23 with EES: 26 lesions, 7 625 struts; 23 with BES: 26 lesions, 6 140 struts; 28 with BVS: 33 lesions, 10 891 struts). OCT images were acquired using the pullback and nonocclusive flushing technique and analysed offline. RESULTS BVS demonstrated fewer uncovered struts per patient (12 ± 27 [3.8 ± 8.4%] vs 59 ± 55 [21.8 ± 13.7%] in the EES&BES group, p <0.001), and thicker neointimal hyperplasia (BVS 102 ± 44 µm vs EES&BES 66 ± 36 µm, p <0.01). There was no significant difference with regard to malapposed struts (2.1 ± 2.7% in the BVS vs 4.4 ± 8.8% in the EES&BES group, p = 0.41). In a predefined signal intensity scale, quantitative analysis of the "key component" (black) revealed lower intensity in BVS than EES&BES (14 ± 23% vs 13 ± 12%, p = 0.007). Intensity was lower in polylactide-containing stents (BVS&BES) than in EES (15 ± 19% vs 10 ± 10%, p <0.001). CONCLUSIONS BVS has fewer uncovered struts and presents with a thicker neointimal coverage compared with EES&BES. It is not known whether this improved capping correlates with superior vascular healing. Polylactide-containing stents (BVS and BES) demonstrate lower peristrut intensity compared with EES.
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Affiliation(s)
| | - Diego Arroyo
- Hospital and University Fribourg, Fribourg, Switzerland
| | - Mario Togni
- Hospital and University Fribourg, Fribourg, Switzerland
| | - Sonja Lehman
- Hospital and University Fribourg, Fribourg, Switzerland
| | - Noé Corpataux
- Hospital and University Fribourg, Fribourg, Switzerland
| | - Malica Cook
- Hospital and University Fribourg, Fribourg, Switzerland
| | | | | | | | | | | | - Stéphane Cook
- Hospital and University Fribourg, Fribourg, Switzerland
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Puricel S, Arroyo D, Corpataux N, Baeriswyl G, Lehmann S, Kallinikou Z, Muller O, Allard L, Stauffer JC, Togni M, Goy JJ, Cook S. Comparison of everolimus- and biolimus-eluting coronary stents with everolimus-eluting bioresorbable vascular scaffolds. J Am Coll Cardiol 2015; 65:791-801. [PMID: 25720622 DOI: 10.1016/j.jacc.2014.12.017] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [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: 08/17/2014] [Revised: 11/18/2014] [Accepted: 12/02/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The first CE-approved bioresorbable vascular scaffold (BVS) is effective at treating simple lesions and stable coronary artery disease, but it has yet to be assessed versus the best-in-class drug-eluting stents (DES). OBJECTIVES This study sought to compare the performance of a BVS with that of everolimus-eluting stents (EES) and biolimus-eluting stents (BES) in all-comer patients. METHODS The EVERBIO II (Comparison of Everolimus- and Biolimus-Eluting Stents With Everolimus-Eluting Bioresorbable Vascular Scaffold Stents II) trial was a single-center, assessor-blinded study of 240 patients randomly assigned in a 1:1:1 ratio to EES, BES, or BVS. The only exclusion criterion was a reference vessel diameter >4.0 mm, which precluded treatment with BVS. The primary endpoint was angiographic late lumen loss (LLL) at 9 months. Secondary endpoints included patient-oriented major acute coronary events (MACE) (death, myocardial infarction [MI], and any revascularization), device-oriented MACE (cardiac death, MI, and target lesion revascularization), and stent thrombosis at the 9-month clinical follow-up. RESULTS Follow-up angiography was performed in 216 patients (90.7%) at 9 months. In-stent LLL was similar between patients treated with BVS (0.28 ± 0.39 mm) and those treated with EES/BES (0.25 ± 0.36 mm; p = 0.30). Clinical outcomes were similar at 9 months: the patient-oriented MACE rate was 27% in BVS and 26% in the EES/BES group (p = 0.83) and the device-oriented MACE rate was 12% in BVS and 9% in the EES/BES group (p = 0.6). CONCLUSIONS New-generation metallic DES (EES/BES) were not superior to BVS in terms of angiographic LLL and clinical outcomes. (Comparison of Everolimus- and Biolimus-Eluting Stents With Everolimus-Eluting Bioresorbable Vascular Scaffold Stents [EVERBIO II]; NCT01711931).
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Affiliation(s)
- Serban Puricel
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Diego Arroyo
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Gérard Baeriswyl
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Sonja Lehmann
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | | | - Olivier Muller
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Ludovic Allard
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | | | - Mario Togni
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland.
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Arroyo D, Togni M, Puricel S, Gerard B, Sonja L, Corpataux N, Villeneuve H, Boute E, Stauffer JC, Goy JJ, Cook S. Comparison of everolimus-eluting and biolimus-eluting coronary stents with everolimus-eluting bioresorbable scaffold: study protocol of the randomized controlled EVERBIO II trial. Trials 2014; 15:9. [PMID: 24398143 PMCID: PMC3926690 DOI: 10.1186/1745-6215-15-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Second-generation everolimus-eluting stents (EES) and third generation biolimus-eluting stents (BES) have been shown to be superior to first-generation paclitaxel-eluting stents (PES) and second-generation sirolimus-eluting stents (SES). However, neointimal proliferation and very late stent thrombosis is still an unresolved issue of drug-eluting stent (DES) implantation overall. The Absorb™ (Abbott Vascular, Abbott Park, IL, USA) is the first CE approved DES with a bioresorbable vascular scaffold (BVS) thought to reduce long-term complication rates. The EVERBIO II trial was set up to compare the BVS safety and efficacy with both EES and BES in all patients viable for inclusion. METHODS/DESIGN The EVERBIO II trial is a single-center, assessor-blinded, randomized trial. The study population consists of all patients aged≥18 years old undergoing percutaneous coronary intervention. Exclusion criterion is where the lesion cannot be treated with BVS (reference vessel diameter>4.0 mm). A total of 240 patients will be enrolled and randomly assigned into 3 groups of 80 with either BVS, EES or BES implantation. All patients will undergo a follow-up angiography study at 9 months. Clinical follow-up for up to 5 years will be conducted by telephone. The primary endpoint is in-segment late lumen loss at 9 months measured by quantitative coronary angiography. Secondary endpoints are patient-oriented major adverse cardiac event (MACE) (death, myocardial infarction and target-vessel revascularization), device-oriented MACE (cardiac death, myocardial infarction and target-lesion revascularization), stent thrombosis according to ARC and binary restenosis at follow-up 12 months angiography. DISCUSSION EVERBIO II is an independent, randomized study, aiming to compare the clinical efficacy, angiographic outcomes and safety of BVS, EES and BES in all comer patients. TRIAL REGISTRATION The trial listed in clinicaltrials.gov as NCT01711931.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Stéphane Cook
- Department of Cardiology, University & Hospital, Fribourg, Switzerland.
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Burch MA, Cochard B, Corpataux N, Passaplan C, Rayroux C. [Shortage of physicians in the canton of Fribourg. Crossing general practitioners in Canton with medical students of Fribourg]. Rev Med Suisse 2013; 9:1328-1329. [PMID: 23875263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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