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Tanner R, Farhan S, Giustino G, Sartori S, Feng Y, Hooda A, Vinayak M, Dangas G, Mehran R, Kini AS, Sharma SK. Impact of diabetes mellitus on clinical outcomes after first episode in-stent restenosis PCI: Results from a large registry. Int J Cardiol 2024; 401:131856. [PMID: 38360097 DOI: 10.1016/j.ijcard.2024.131856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/02/2024] [Accepted: 02/10/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with a high rate of major adverse cardiac events (MACE) after de novo coronary artery percutaneous coronary intervention (PCI). Whether patients with DM undergoing PCI for in-stent restenosis (ISR) experience a similar heightened risk of MACE is not known. Hence, we sought to compare the clinical outcomes of patients with and without DM undergoing PCI for ISR. METHODS Patients undergoing first episode ISR PCI between January 2015 and December 2021 were included. The primary outcome of interest was MACE (all-cause death, myocardial infarction [MI], and target lesion revascularization [TVR]) at 1-year. RESULTS A total of 3156 patients (56.7% with DM) underwent PCI for ISR during the study period. Patients with DM were younger, more likely to be female, and had a higher prevalence of comorbidities. At 1-year follow-up, DM was associated with a higher rate of MACE (22.4% vs. 18.7%, unadjusted HR 2.03, 95%CI(1.27-3.25), p = 0.003). All-cause mortality and MI were significantly more frequent among people with DM at 1-year follow-up. The rate of TVR was similar in both groups (17.9% vs. 16.0%, unadjusted HR 1.14, 95%CI (0.94-1.37), p = 0.180). On adjusted analysis, there was no significant difference in the rate of MACE (AHR 1.07, 95%CI(0.90 - -1.29), p = 0.444), all-cause death (AHR 1.54, 95%CI(0.93-2.54), p = 0.095) or MI (AHR 1.10, 95%CI(0.74-1.63), p = 0.652). CONCLUSION ISR PCI in patients with DM was associated with a higher rate of MACE at 1-year follow-up. However, this increased risk was no longer significant after adjusting for baseline characteristics.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Serdar Farhan
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Gennaro Giustino
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Samantha Sartori
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Yihan Feng
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Amit Hooda
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Manish Vinayak
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - George Dangas
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Roxana Mehran
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Annapoorna S Kini
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Samin K Sharma
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, USA.
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Khan MR, Koshy AN, Tanner R, Farhan S, Vinayak M, Farooq A, Sartori S, Feng Y, Spirito A, Arora A, Dhulipala V, Kapur V, Suleman J, Sharma R, Mehran R, Kini A, Sharma SK. Real-World Comparison of Clopidogrel With Ticagrelor and Prasugrel in Patients With Chronic Coronary Disease Who Underwent Atherectomy. Am J Cardiol 2024; 217:1-4. [PMID: 38401658 DOI: 10.1016/j.amjcard.2024.02.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Mahin R Khan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ali Farooq
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yihan Feng
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ayush Arora
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Kapur
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Javed Suleman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raman Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Vinayak M, Cao D, Tanner R, Koshy AN, Farhan S, Vogel B, Sartori S, Feng Y, Dhulipala V, Arora A, Dangas GD, Kini AS, Sharma SK, Mehran R. Impact of Bleeding Risk and Inflammation on Cardiovascular Outcomes After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2024; 17:345-355. [PMID: 38355263 DOI: 10.1016/j.jcin.2023.12.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Markers of systemic inflammation, such as high-sensitivity C-reactive protein (hsCRP), have been associated with the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Whether this risk varies according to the presence of high bleeding risk (HBR) conditions is unclear. OBJECTIVES The aim of this study was to evaluate the impact of systemic inflammation, as measured by hsCRP levels and cardiovascular outcomes in patients stratified by HBR status following PCI. METHODS Consecutive patients undergoing PCI between 2012 and 2019 with baseline hsCRP levels were included. High hsCRP was defined as >3 mg/L, and HBR was defined per the Academic Research Consortium HBR criteria. The primary outcome was MACCE, including all-cause death, myocardial infarction, or stroke at 1 year. All bleeding was assessed as a secondary outcome. RESULTS A total of 15,150 patients were included, and 40.4% (n = 6,125) qualified as HBR. The adjusted risk for MACCE was consistently higher in patients with high hsCRP in both HBR (adjusted HR [aHR]: 1.49; 95% CI: 1.18-1.87) and non-HBR (aHR: 1.87; 95% CI: 1.31-2.66) subgroups, with no interaction between HBR status and hsCRP level (Pinteraction = 0.26). Conversely, although bleeding risk was higher in the HBR cohort, hsCRP did not predict the occurrence of bleeding in either the HBR (aHR: 1.04; 95% CI: 0.82-1.31) or the non-HBR (aHR: 0.99; 95% CI: 0.71-1.39) subgroup (Pinteraction = 0.539). CONCLUSIONS Elevated hsCRP at the time of PCI is associated with a higher risk for ischemic but not bleeding events, irrespective of HBR status.
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Affiliation(s)
- Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology and the University of Melbourne, Melbourne, Australia
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yihan Feng
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ayush Arora
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Spirito A, Cohen R, Sartori S, Vogel B, Baber U, Pileggi B, Smith K, Nicosia D, Kamaleldin K, Farhan S, Kini A, Sharma SK, Dangas G, Mehran R. Prognostic impact of peripheral artery disease in patients with and without high bleeding risk undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2024; 103:425-434. [PMID: 38314901 DOI: 10.1002/ccd.30960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with worse outcomes after percutaneous coronary intervention (PCI). The aim of this study was to assess the prognostic impact of PAD according to high bleeding risk (HBR) status. METHODS Consecutive patients undergoing PCI with drug-eluting stent implantation at a tertiary-care center (Mount Sinai Hospital) between 2012 and 2019 were stratified according to HBR and PAD status. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and stroke 1 year after PCI. Secondary outcomes included major bleeding. RESULTS Out of 16,750 patients, 43% were HBR and 57% were no-HBR. Within the two groups, PAD patients were 14% and 6%, respectively, and were more likely to have comorbidities and to undergo complex PCI than no-PAD patients. Within the HBR group, PAD was associated with an increased risk of MACE (11.4% vs. 7.3%, hazard ratio [HR]: 1.59, 95% confidence interval [CI]: 1.27-1.99, p < 0.001) and a numerical nonsignificant increase of major bleeding (8.5% vs. 6.9%, HR: 1.25, 95% CI: 0.98-1.59, p = 0.066) as compared with no-PAD. Among no-HBR patients, rates of MACE and major bleeding were numerically but not significantly higher in the PAD group. After multivariable adjustment, PAD was no longer a predictor of adverse outcomes, irrespective of HBR status. CONCLUSIONS At 1-year after PCI, PAD was associated with increased 1-year risks of MACE in HBR patients. After adjustment for cardiovascular risk factors and comorbidities, the effect of PAD on adverse events was largely attenuated.
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Affiliation(s)
- Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Cohen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Brunna Pileggi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil
| | - Kenneth Smith
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Nicosia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karim Kamaleldin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Upadhaya S, Upreti A, Madala S, Gaddam A, Upadhrasta S, Farhan S, Wiley J. Efficacy and safety of drug-eluting stents compared with bare metal stent for femoropopliteal artery lesions. Cardiovasc Revasc Med 2023:S1553-8389(23)00971-5. [PMID: 38185593 DOI: 10.1016/j.carrev.2023.12.017] [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] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Sunil Upadhaya
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Alina Upreti
- Department of Biomedical Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Anurag Gaddam
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sireesha Upadhrasta
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Jose Wiley
- Section of Cardiology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Tscharre M, Farhan S, Freynhofer MK, Vogel B, Tinhofer F, Rohla M, Weiss TW, Wojta J, Huber K, Tentzeris I, Ay C. Blood group non-O is not associated with long-term adverse outcomes in patients undergoing percutaneous coronary intervention. Thromb Res 2023; 229:127-130. [PMID: 37441928 DOI: 10.1016/j.thromres.2023.04.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Maximilian Tscharre
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | - Matthias K Freynhofer
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | - Florian Tinhofer
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria
| | - Miklos Rohla
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria; Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas W Weiss
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria; Sigmund-Freud University, Medical School, Vienna, Austria
| | - Johan Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria; Sigmund-Freud University, Medical School, Vienna, Austria
| | - Ioannis Tentzeris
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring, Vienna, Austria.
| | - Cihan Ay
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Hemetsberger R, Mankerious N, Toelg R, Abdelghani M, Farhan S, Garcia-Garica HM, Allali A, Windecker S, Lefèvre T, Saito S, Kandzari D, Waksman R, Richardt G. Patients with higher-atherothrombotic risk vs. lower-atherothrombotic risk undergoing coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials. Clin Res Cardiol 2023; 112:1278-1287. [PMID: 37062047 DOI: 10.1007/s00392-023-02205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with atherothrombotic risk are at high hazard of ischemic events. Preventive medicine plays a major role in modifying their outcomes. Whether the choice of a BP-SES or DP-EES can contribute to the occurrence of events remains unclear. We sought to investigate the outcomes of patients with higher atherothrombotic risk (H-ATR) versus lower atherothrombotic risk (L-ATR) undergoing percutaneous coronary intervention (PCI) with either bioresorbable-polymer sirolimus-eluting stent (BP-SES) or durable-polymer everolimus-eluting stent (DP-EES). METHODS Patients (n = 2361) from BIOFLOW-II, -IV, and -V randomized trials were categorized into H-ATR vs. L-ATR. L-ATR patients had ≤ 1 and H-ATR ≥ 2 of the following criteria: presentation in ACS, diabetes mellitus, previous myocardial infarction, previous PCI/CABG, or previous stroke. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], target lesion revascularization [TLR]) and stent thrombosis (ST) at three years. RESULTS H-ATR patients (n = 1023) were more morbid than L-ATR patients (n = 1338). TLF rate was significantly higher in H-ATR patients as compared with L-ATR (11.6% vs. 7.0%; HR 1.67, 95% CI 1.27-2.20, p < 0.0001). With BP-SES TLF rates were numerically lower as compared with DP-EES in H-ATR (10.5% vs. 13.5%; HR 0.78, 95% CI 0.54-1.14, p = 0.20) and significantly lower in L-ATR (5.6% vs. 9.8%; HR 0.57, 95% CI 0.38-0.85, p = 0.006). CONCLUSION In the era of newer-generation DES, patients with H-ATR still are at hazard for ischemic events. Patients with BP-SES had lower TLF rates as compared with DP-EES, most consistent in L-ATR whereas in H-ATR patients most probably secondary preventive strategies are of higher value. CLINICAL TRIAL REGISTRATION Clinicaltrial.gov. NCT01356888, NCT01939249, NCT02389946. https://clinicaltrials.gov/show/NCT01356888 , https://clinicaltrials.gov/show/NCT01939249 , https://clinicaltrials.gov/show/NCT02389946 .
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Affiliation(s)
- Rayyan Hemetsberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt
- Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | | | | | | | | | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Ron Waksman
- Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
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8
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Farooq A, Koshy AN, Giustino G, Sartori S, Snyder C, Hooda A, Farhan S, Kyaw H, Khan M, Vinayak M, Arora A, Dhulipala V, Suleman J, Krishnamoorthy P, Khera S, Sweeny J, Mehran R, Kini AS, Sharma SK. Impact of Clinical Presentation on Outcomes After Rotational Atherectomy in Patients Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2023; 201:252-259. [PMID: 37393727 DOI: 10.1016/j.amjcard.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 07/04/2023]
Abstract
Rotational atherectomy (RA) is widely used in the percutaneous treatment of heavily calcified coronary artery lesions in patients with chronic coronary syndromes (CCS). However, the safety and efficacy of RA in acute coronary syndrome (ACS) is not well established and is considered a relative contraindication. Therefore, we sought to evaluate the efficacy and safety of RA in patients presenting with non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and CCS. Consecutive patients who underwent percutaneous coronary intervention with RA between 2012 and 2019 at a tertiary single center were included. Patients presenting with ST-elevation myocardial infarction (MI) were excluded. The primary end points of interest were procedural success and procedural complications. The secondary end point was the risk of death or MI at 1 year. A total of 2,122 patients who underwent RA were included, of whom 1,271 presented with a CCS (59.9%), 632 presented with UA (29.8%), and 219 presented with NSTEMI (10.3%). Although an increased rate of slow-flow/no-reflow was noted in the UA population (p = 0.03), no significant difference in procedural success or procedural complications, including coronary dissection, perforation, or side-branch closure, was noted (p = NS). At 1 year, there were no significant differences in death or MI between CCS and non-ST-elevation ACS (NSTE-ACS: UA + NSTEMI; adjusted hazard ratio 1.39, 95% confidence interval 0.91 to 2.12); however, patients who presented with NSTEMI had a higher risk of death or MI than CCS (adjusted hazard ratio 1.79, 95% confidence interval 1.01 to 3.17). Use of RA in NSTE-ACS was associated with similar procedural success without an increased risk of procedural complications compared with patients with CCS. Although patients presenting with NSTEMI remained at higher risk of long-term adverse events, RA appears to be safe and feasible in patients with heavily calcified coronary lesions presenting with NSTE-ACS.
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Affiliation(s)
- Ali Farooq
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, The Royal Melbourne Hospital, Australia
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Htoo Kyaw
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mahin Khan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ayush Arora
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Javed Suleman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Krishnan P, Sharma R, Avadhani S, Tarricone A, Gee A, Farhan S, Kamran H, Kini A, Sharma S. IVUS Improves Outcomes With SUPERA Stents for the Treatment of Superficial Femoral-Popliteal Artery Disease. J Endovasc Ther 2023:15266028231182226. [PMID: 37350335 DOI: 10.1177/15266028231182226] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nitinol interwoven bare metal stents represent an advancement in stent technology; however, nominal deployment remains an area of focus. Intravascular ultrasound (IVUS) has been shown to improve outcomes in both the coronary and peripheral vasculature by providing the operator with greater vessel detail; however, the use of adjunctive IVUS with nitinol bare metal stents has not been widely studied. This studies aims to determine the effect of IVUS when used adjunctively with nitinol interwoven bare metal stents in the management of femoropopliteal lesions. DESIGN Retrospective study. METHODS This study included a cohort of 200 consecutive patients with peripheral artery disease. All patients were treated with ≥1 Supera bare metal stent, and 91 received adjunctive IVUS imaging prior to stent deployment. Deployment conditions of nominal, compressed, and elongated were measured, and the primary clinical outcomes included target lesion reintervention, amputation, and mortality. This study also showed that 8.3 number needed to treat (NNT) patients must be treated with IVUS to avoid an additional revascularization event. RESULTS The patients who received IVUS had a significantly greater number of nominally deployed stents (p<0.001). Patients who had IVUS imaging also had significantly lower reintervention rates compared with those who did not receive IVUS imaging (p=0.047). CONCLUSION The IVUS and angiography decreases clinically-driven target lesion reintervention and increases nominal deployment compared with angiography alone in femoropopliteal lesions treated with interwoven bare metal nitinol stents. CLINICAL IMPACT Endovascular surgones may conisder the adjuctive use of IVUS when using the Supera stent for the treatment of infra inguinal superficial femoral artery lesions. The adjunct use of IVUS may lead to improved sizing, vessel prep, deployment, and ultiamtely reduction in CD-TLR.
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Affiliation(s)
- Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raman Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sriya Avadhani
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Tarricone
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Gee
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon Kamran
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Iruvanti S, Blumfield A, Farhan S, Snyder C, Johal G, Sartori S, Vogel B, Giustino G, Melarcode-Krishnamoorthy P, Kyaw H, Dangas G, Mehran R, Kini A, Sharma SK. Determinants of Seattle Angina Questionnaire in Multivessel Disease Patients Undergoing Percutaneous Coronary Intervention: Insights from a Single-Center Study. Cardiovasc Revasc Med 2023; 49:28-33. [PMID: 36624012 DOI: 10.1016/j.carrev.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The Seattle Angina Questionnaire (SAQ-7) quantifies the impact of angina on patient functionality and quality of life. There is scarce data on the impact of social determinants and comorbidities on SAQ-7 in patients undergoing percutaneous coronary intervention (PCI) with planned staged PCI. METHODS Patients completed a SAQ-7 before each PCI. Multivariable regression analysis was performed to study the impact of social determinants, comorbidities, and procedural characteristics on SAQ-7 scores at index PCI and at the time of the staged PCI. RESULTS 531 patients were studied. Female sex, non-White race, coronary artery bypass graft history (CABG), and chronic lung disease were associated with lower baseline SAQ-7 scores. Overall, SAQ-7 increased between index procedure and staged PCI (11.9 ± 23.4). Body mass index (BMI) and the treatment of bifurcation lesions were independently associated with improvement of SAQ-7 between PCIs. Post-intervention, neither sex nor race was independently associated with changes in SAQ-7 scores. CONCLUSION Different disparities and comorbid factors affect SAQ-7 before and after PCI. After revascularization, sex and race were not independent predictors of SAQ-7 improvement.
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Affiliation(s)
- Suvruta Iruvanti
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Amit Blumfield
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gurpreet Johal
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Parasuram Melarcode-Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Htoo Kyaw
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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11
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Giustino G, Kyaw H, Sartori S, Farhan S, Dangas G, Sweeny J, Mehran R, Kini A, Sharma SK. Trends in Vascular Access Site Use and Outcomes in Patients Undergoing PCI. Am J Cardiol 2023; 195:1-2. [PMID: 36989603 DOI: 10.1016/j.amjcard.2023.02.019] [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] [Received: 02/09/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Htoo Kyaw
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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12
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Salehi N, Dhulipala V, Koshy AN, Giustino G, Sartori S, Dangas GD, Snyder C, Contreras JP, Farhan S, Sweeny JM, Kini AS, Mehran R, Sharma SK. CHANGES IN LV EJECTION FRACTION AND OUTCOMES AFTER PCI IN PATIENTS WITH SEVERE ISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01240-8] [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: 03/06/2023]
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13
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Koshy AN, Giustino G, Sartori S, Sharma A, Smith K, Feng Y, Farhan S, Krishnamoorthy PM, Mehran R, Kini AS, Sharma SK. PATIENT REFUSAL, SURGICAL INELIGIBILITY AND MORTALITY IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01286-x] [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: 03/06/2023]
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Farhan S, Enzmann FK, Bjorkman P, Kamran H, Zhang Z, Sartori S, Vogel B, Tarricone A, Linni K, Venermo M, van der Veen D, Moussalli H, Mehran R, Reijnen MMPJ, Bosiers M, Krishnan P. Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease. J Am Coll Cardiol 2023; 81:358-370. [PMID: 36697136 DOI: 10.1016/j.jacc.2022.10.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND No adequately powered studies exist to compare major clinical outcomes after endovascular therapy (EVT) with stent implantation vs bypass surgery (BSx) for symptomatic femoropopliteal peripheral artery disease. OBJECTIVES This study sought to perform a pooled analysis of individual patient data from all randomized controlled trials comparing EVT vs BSx. METHODS Principal investigators of 5 of 6 available randomized controlled trials agreed to pool individual patient data. The primary endpoint was major adverse limb events, a composite of all-cause death, major amputation, or target limb reintervention. Secondary endpoints included amputation-free survival, individual major adverse limb event components, and primary patency. Early complications were bleeding, infection, or all-cause death within 30 days. RESULTS A total of 639 patients were analyzed with a mean age of 68.1 ± 9.1 years and 29.0% women. Baseline characteristics were comparable between groups. At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding major adverse limb events (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% CI: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT vs those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001). CONCLUSIONS These findings further support the efficacy and safety of EVT as an alternative to BSx in patients with symptomatic femoropopliteal peripheral artery disease.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Florian K Enzmann
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrick Bjorkman
- Department of Cardiac, Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Haroon Kamran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthur Tarricone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Klaus Linni
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Maarit Venermo
- Department of Cardiac, Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Herve Moussalli
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Marc Bosiers
- A.Z. Sint-Blasius Hospital, Dendermonde, Belgium
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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15
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Farhan S, Silbiger JJ, Halperin JL, Zhang L, Dukkipati SR, Vogel B, Kini A, Sharma S, Lerakis S. Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:2314-2330. [PMID: 36480974 DOI: 10.1016/j.jacc.2022.09.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 12/07/2022]
Abstract
The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR-atrial functional MR (AF-MR)-is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey J Silbiger
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York, USA.
| | - Jonathan L Halperin
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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16
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Krishnan P, Sharma R, Avadhani S, Tarricone A, Gee A, Farhan S, Kamran H, Kini A, Sharma S. Drug coated balloon improves outcomes of sub-optimal Supera deployment in the intermediate term. Sci Rep 2022; 12:21327. [PMID: 36494491 PMCID: PMC9734119 DOI: 10.1038/s41598-022-25634-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Sub-Optimal deployment of Self expanding interwoven stents (Supera) has been shown to increase the rate of Clinically Driven Target Lesion Revascularization (CD-TLR). Meanwhile, drug coated balloons (DCB) have been shown to reduce CD-TLR in the femoral-popliteal segment in de- novo and restenotic lesions. However, the clinical effects of vessel preparation with DCB in nominal, compressed, and elongated Supera has not been widely studied. The purpose of this study is to assess the outcomes of clinically driven re-intervention, major amputations, and mortality in relation to the use of DCB as vessel preparation in different deployment conditions (nominal, compressed, elongated) of the Supera stent. Patient chart data was collected at a single center hospital between March 2015 and May 2020. All patients were adults (≥ 18 years old) and were treated with at least one (≥ 1) Supera stent. Deployment status was extrapolated from anonymized angiograms. The primary endpoint of this study was CD-TLR. Secondary endpoints included amputation and mortality rates associated with each deployment condition. A total of 670 limbs were treated and patients were followed for 36 months. Nominal stent deployment was observed in 337 limbs, followed by elongated condition (n = 176), then by compressed conditions (n = 159). CD-TLR was observed most frequently with elongated deployment. Drug coated balloons were used as vessel prep prior to stenting and showed a protective effect regardless of deployment status; O.R = 0.44 (CI 0.30-0.66, p < .05).
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Affiliation(s)
- Prakash Krishnan
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
| | - Raman Sharma
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Sriya Avadhani
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Arthur Tarricone
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Allen Gee
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Serdar Farhan
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Haroon Kamran
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Annapoorna Kini
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Samin Sharma
- Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
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Farhan S, Stachel G, Desch S, Kurz T, Feistritzer HJ, Hartung P, Eitel I, Nef H, Doerr O, Lauten A, Landmesser U, Sandri M, Holzhey D, Borger M, Ince H, Öner A, Meyer-Saraei R, Wienbergen H, Fach A, Frey N, de Waha-Thiele S, Thiele H. Impact of moderate or severe left ventricular outflow tract calcification on clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation with self- and balloon-expandable valves: a post hoc analysis from the SOLVE-TAVI trial. EUROINTERVENTION 2022; 18:759-768. [DOI: 10.4244/eij-d-22-00156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hooda A, Yadav M, Bagga S, Koshy A, Dwivedi P, Gedela M, Sartori S, Snyder C, Thapi R, Bande P, Vijay P, Kyaw H, Ranadive I, Kumar K, Farhan S, Goel S, Krishnamoorthy P, Dangas G, Mehran R, Kini A, Sharma S. TCT-543 Clinical and Procedural Risk Predictors of Acute Kidney Injury Following Transcatheter Aortic Valve Replacement: Findings From a Real-World Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Iruvanti S, Blumfield A, Farhan S, Snyder C, Sartori S, Vogel B, Giustino G, Kyaw H, Dangas G, Mehran R, Kini A, Sharma S. TCT-105 Determinants of Seattle Angina Questionnaire in Multivessel Disease Patients Undergoing Percutaneous Coronary Intervention: Insights From a Single-Center Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Krishnan P, Farhan S, Schneider P, Kamran H, Iida O, Brodmann M, Micari A, Sachar R, Urasawa K, Scheinert D, Ando K, Tarricone A, Doros G, Tepe G, Yokoi H, Laird J, Zeller T. Determinants of Drug-Coated Balloon Failure in Patients Undergoing Femoropopliteal Arterial Intervention. J Am Coll Cardiol 2022; 80:1241-1250. [DOI: 10.1016/j.jacc.2022.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/05/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023]
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21
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Jou S, Vogel B, Snyder C, Sartori S, Farhan S, Nicolas J, Cao D, Moreno P, Sweeny J, Krishnan P, Dangas G, Kini A, Sharma S. TCT-566 Impact of Sex on Risk for Adverse Events Associated With Polyvascular Disease in Patients After PCI. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Spirito A, Cao D, Sartori S, Zhang Z, Nicolas J, Cohen D, Angiolillo D, Briguori C, Vogel B, Collier T, Dudek D, Escaned J, Sharma S, Farhan S, Huber K, Kastrati A, Kornowski R, Krucoff M, Kunadian V, Mehta S, Moliterno D, Ohman EM, Sardella G, Shlofmitz R, Steg P, Witzenbichler B, Han Y, Pocock S, Dangas G, Mehran R. TCT-13 Ticagrelor Monotherapy in Patients With Peripheral Artery Disease Undergoing PCI. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.022] [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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23
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Garg A, Rout A, Farhan S, Waxman S, Giustino G, Tayal R, Abbott JD, Huber K, Angiolillo DJ, Rao SV. Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis. Am Heart J 2022; 250:1-10. [PMID: 35436504 DOI: 10.1016/j.ahj.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Optimal dual antiplatelet therapy (DAPT) duration in patients at high bleeding risk (HBR) is not fully defined. We aimed to compare the safety and effectiveness of short-term DAPT (S-DAPT) with longer duration DAPT (L-DAPT) after percutaneous coronary intervention (PCI) with drug eluting stents (DES) in patients at HBR. METHODS We searched for studies comparing S-DAPT (≤3 months) followed by aspirin or P2Y 12 inhibitor monotherapy against L-DAPT (6-12 months) after PCI in HBR patients. Primary end points of interest were major bleeding and myocardial infarction (MI). Random-effects meta-analyses were performed to calculate odds ratios with 95% CIs. RESULTS Six randomized trials and 3 propensity-matched studies (n = 16,848) were included in the primary analysis. Compared with L-DAPT (n = 8,422), major bleeding was lower with S-DAPT (n = 8,426) [OR 0.68; 95% CI 0.51-0.89] whereas MI did not differ significantly between the 2 groups [1.16; 0.94-1.44]. There were no significant differences in risks of death, stroke or stent thrombosis (ST) between S-DAPT and L-DAPT groups. These findings were consistent when propensity-matched studies were analysed separately. Finally, there was a numerically higher, albeit statistically non-significant, ST in the S-DAPT arm of patients without an indication for OAC [1.98; 0.86-4.58]. CONCLUSIONS Among HBR patients undergoing current generation DES implantation, S-DAPT reduces bleeding without an increased risk of death or MI compared with L-DAPT. More research is needed to (1) evaluate risks of late ST after 1 to 3 months DAPT among patients with high ischemic and bleeding risks, (2) defining the SAPT of choice after 1 to 3 months DAPT.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Brown University, Providence, RI.
| | - Amit Rout
- Division of Cardiology, University of Louisville, Louisville, KY
| | - Serdar Farhan
- Division of Cardiology, Icahn school of Medicine at Mount Sinai, New York, NY
| | - Sergio Waxman
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Gennaro Giustino
- Division of Cardiology, University of Louisville, Louisville, KY
| | - Raj Tayal
- Division of Cardiology, Valley Hospital, Ridgewood, NJ
| | | | - Kurt Huber
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC
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24
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Tscharre M, Farhan S, Freynhofer MK, Leutner M, Baumgartner-Parzer S, Tentzeris I, Vogel B, Tinhofer F, Rohla M, Weiss TW, Huber K, Kautzky-Willer A. Neurotensin and Adverse Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:782602. [PMID: 35345492 PMCID: PMC8957262 DOI: 10.3389/fcvm.2022.782602] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Neurotensin is involved in fatty acid and glucose metabolism and promotes the development of obesity and diabetes. These associations appear to be more pronounced in women. We investigated the association of neurotensin with long-term major adverse cardiovascular events (MACE) in patients presenting with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). Methods We included 452 consecutive patients [144 (31.9%) females] undergoing PCI for ACS or CCS. Plasma samples drawn after PCI were analyzed for neurotensin with an enzyme-linked immunoassay. As primary endpoint, a composite of MACE including all-cause death, non-fatal myocardial infarction and non-fatal stroke during 7 years of follow-up was investigated. As secondary endpoint, we investigated all-cause death. Results Neurotensin levels did not differ between male and female patients (p = 0.560). MACE occurred in 150 (33.2%) patients. Restricted cubic splines demonstrated a U-shaped association of log-transformed neurotensin with the primary and secondary endpoint. Therefore, we dichotomized our cohort according to tertiles of log-transformed neurotensin. In Kaplan-Meier analysis including the total cohort and restricted to male patients log- neurotensin tertiles were not associated with MACE (both p > 0.05). Moreover, in the overall cohort and in male patients multivariable Cox regression analysis log-neurotensin tertiles were not associated with MACE or with all-cause death (all p > 0.05). However, in female patients log-neurotensin was associated with MACE in Kaplan-Meier analysis (log-rank p = 0.013). Also, after multivariable adjustment female patients in the first tertile had a significantly increased risk for MACE compared to female patients in the second tertile [HR 3.84 (95% CI 1.71–8.60), p = 0.001]. There was tendency for increased risk in female patients in the third tertile compared to the second tertile [HR 2.14 (95% CI 0.97–4.73), p = 0.058]. Moreover, in female patients the [first and the third tertile of log- neurotensin were associated with all-cause death 1s vs. 2nd tertile: HR 3.03 (95% CI 1.21–7.63), p = 0.018; 3rd vs. 2nd tertile: HR 3.01 (95% CI 1.22–7.44), p = 0.016]. Conclusion In female patients with CAD undergoing PCI, neurotensin has a U-shaped relationship with adverse outcomes. These data suggest a sex specific association between neurotensin and long-term adverse events after PCI.
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Affiliation(s)
- Maximilian Tscharre
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
- Institute of Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthias K. Freynhofer
- Medical Department, Cardiology and Intensive Care Medicine, Hospital Ottakring, Vienna, Austria
| | - Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Ioannis Tentzeris
- Medical Department, Cardiology and Intensive Care Medicine, Hospital Ottakring, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Florian Tinhofer
- Medical Department, Cardiology and Intensive Care Medicine, Hospital Ottakring, Vienna, Austria
| | - Miklos Rohla
- Institute of Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
- Medical Department, Cardiology and Intensive Care Medicine, Hospital Ottakring, Vienna, Austria
| | - Thomas W. Weiss
- Institute of Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
- Medical School, Sigmund-Freud University, Vienna, Austria
| | - Kurt Huber
- Medical Department, Cardiology and Intensive Care Medicine, Hospital Ottakring, Vienna, Austria
- Medical School, Sigmund-Freud University, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
- Gender Institute, Lapura Women's Health Resort, Gars am Kamp, Austria
- *Correspondence: Alexandra Kautzky-Willer
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25
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Hemetsberger R, Abdelghani M, Toelg R, Garcia-Garcia HM, Farhan S, Mankerious N, Elbasha K, Allali A, Windecker S, Lefèvre T, Saito S, Kandzari D, Waksman R, Richardt G. Complex vs. non-complex percutaneous coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials. Clin Res Cardiol 2022; 111:795-805. [PMID: 35212802 DOI: 10.1007/s00392-022-01994-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing complex percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation coronary stents. AIM We sought to compare the clinical outcomes after complex PCI with a bioresorbable-polymer sirolimus-eluting stent (BP-SES) versus a durable-polymer everolimus-eluting stent (DP-EES). METHODS Patients (n = 2350) from BIOFLOW-II, -IV, and -V randomized trials were categorized into non-complex PCI vs. complex PCI. Complex PCI had at least one of the following criteria: multi-vessel PCI, ≥ 3 lesions treated, ≥ 3 stents implanted, total stent length ≥ 60 mm. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], or target lesion revascularization [TLR]) and probable/definite stent thrombosis (ST) at three years. RESULTS Patients with complex PCI (n = 348) were older and presented more often with acute coronary syndrome than non-complex PCI patients (n = 2002). Complex PCI lesions were more often type B2/C and bifurcation lesions and required more pre- and post-dilatation. Complex PCI patients had higher rates of TLF (14.6% vs. 8.1%; aHR 1.89, 95% CI [1.31-2.73], p = 0.001), TV-MI (10.2% vs. 4.4%, aHR 2.17, 95% CI [1.40-3.37], p = 0.001), and ST (1.5% vs. 0.4%, p = 0.025) as compared with non-complex PCI. TLF was not lower with BP-SES as compared to DP-EES in complex PCI (12.6% vs 18.2%, p = 0.16). CONCLUSION Patients undergoing complex PCI with the newer-generation DES still sustain a higher risk of TLF, TV-MI and stent thrombosis as compared with non-complex PCI. This adverse outcome was not significantly modified by the stent platform (BP-SES vs. DP-EES). CLINICAL TRIAL REGISTRATION Clinicaltrial.gov NCT01356888, NCT01939249, NCT02389946, https://clinicaltrials.gov/show/NCT01356888 ; https://clinicaltrials.gov/show/NCT01939249 ; https://clinicaltrials.gov/show/NCT02389946 .
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Affiliation(s)
- Rayyan Hemetsberger
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany. .,Department of Cardiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany.
| | - Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt.,Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Karim Elbasha
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | | | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Ron Waksman
- Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
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26
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Faries CM, Rao A, Ilonzo N, Hwong S, Krishnan P, Farhan S, Ting W, Vouyouka AG, Tadros RO, Marin ML, Faries PL. Follow-up after acute thrombotic events following COVID-19 infection. Eur J Vasc Endovasc Surg 2022. [PMCID: PMC8853805 DOI: 10.1016/j.ejvs.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Cryer MJ, Farhan S, Kaufmann CC, Jäger B, Garg A, Krishnan P, Mehran R, Huber K. Prothrombotic Milieu, Thrombotic Events and Prophylactic Anticoagulation in Hospitalized COVID-19 Positive Patients: A Review. Clin Appl Thromb Hemost 2022; 28:10760296221074353. [PMID: 35068227 PMCID: PMC8793375 DOI: 10.1177/10760296221074353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 01/08/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality worldwide. Although initial reports concentrated on severe respiratory illness, emerging literature has indicated a substantially elevated risk of thromboembolic events in patients with COVID-19 disease. Pro-inflammatory cytokine release has been linked to endothelial dysfunction and activation of coagulation pathways, as evident by elevated D-dimer levels and deranged coagulation parameters. Both macrovascular and microvascular thromboses have been described in observational cohort and post-mortem studies. Concurrently, preliminary data have suggested the role of therapeutic anticoagulation in preventing major thromboembolic complications in moderately but not critically ill patients. However, pending results from randomized controlled trials, clear guidance is lacking regarding the intensity and duration of anticoagulation in such patients. Herein, we review the existing evidence on incidence and pathophysiology of COVID-19 related thromboembolic complications and guide anticoagulation therapy based on current literature and societal consensus statements.
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Affiliation(s)
- Michael Joseph Cryer
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tucson Medical Center/Tucson Hospitals Medical Education Program, Tucson, Arizona, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Bernhard Jäger
- Wilhelminenhospital, Vienna, Austria
- Sigmund Freud University, Medical School, Vienna, Austria
| | - Aakash Garg
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt Huber
- Wilhelminenhospital, Vienna, Austria
- Sigmund Freud University, Medical School, Vienna, Austria
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28
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Stachel G, Abdel-Wahab M, de Waha-Thiele S, Desch S, Feistritzer HJ, Kitamura M, Farhan S, Eitel I, Kurz T, Thiele H. Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2022; 38:2469-2478. [PMID: 36434335 PMCID: PMC9700572 DOI: 10.1007/s10554-022-02657-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
To evaluate the prognostic relevance of aortic annulus (AA) and left ventricular outflow tract (LVOT) Fractal dimension (FD). FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2 × 2 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75 mm and was compared between patients with none/trivial and mild/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild/moderate PVR (1.0558 ± 0.0289 vs. 1.0401 ± 0.0284, p = 0.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R = 0.337, p < 0.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild/moderate PVR in ROC analysis was 0.661 (0.542-0.779, p = 0.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.Trial Registration: www.clinicaltrials.gov , identifier: NCT02737150, date of registration: 13.04.2016.
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Affiliation(s)
- Georg Stachel
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany ,University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ingo Eitel
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany ,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Lübeck, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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29
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Hemetsberger R, Abdelghani M, Toelg R, Garcia-Garcia H, Farhan S, Elbasha K, Allali A, Windecker S, Lefevre T, Saito S, Kandzari D, Waksman R, Richardt G. TCT-115 Complex Versus Noncomplex Percutaneous Coronary Intervention With Newer-Generation Drug-Eluting Stents: An Analysis From the Randomized BIOFLOW Trials. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Garg A, Farhan S, Rout A, Dangas G. TCT-202 Safety and Efficacy of Low-Dose Direct Oral Anticoagulants for Atherosclerotic Cardiovascular Disease: A Meta-analysis of Randomized Controlled Trials. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Burger AL, Kaufmann CC, Jäger B, Pogran E, Ahmed A, Wojta J, Farhan S, Huber K. Direct cardiovascular complications and indirect collateral damage during the COVID-19 pandemic : A review. Wien Klin Wochenschr 2021; 133:1289-1297. [PMID: 34671829 PMCID: PMC8527966 DOI: 10.1007/s00508-021-01956-2] [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: 06/09/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), puts a heavy strain on healthcare systems around the globe with high numbers of infected patients. Pre-existing cardiovascular disease is a major risk factor for a severe clinical course of COVID-19 and is associated with adverse outcome. COVID-19 may directly exacerbate underlying heart disease and is frequently aggravated by cardiovascular complications, including arterial and venous thromboembolic events, malignant arrhythmia and myocardial injury. In addition to these direct cardiac manifestations of COVID-19, patients with cardiovascular disease face further indirect consequences of the pandemic, as the respective resources in the healthcare systems need to be redirected to cope with the high numbers of infected patients. Consecutively, a substantial decrease in cardiac procedures was reported during the pandemic with lower numbers of coronary angiographies and device implantations worldwide. As a consequence an increased number of out-of-hospital cardiac arrests, late-comers with subacute myocardial infarction and of patients presenting in cardiogenic shock or preshock were observed. Maintenance of high-quality cardiac care by avoiding a reduction of cardiac services is of utmost importance, especially in times of a pandemic.
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Affiliation(s)
- Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria.
| | - Christoph C Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Bernhard Jäger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Edita Pogran
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Amro Ahmed
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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Krishnan P, Tarricone A, Gee A, Farhan S, Kamran H, Kapur V, Gujja K, Kini A, Sharma S. Analysis of Interwoven Nitinol Stenting for the Treatment of Critical Limb Ischemia: Outcomes From an Average 3-Year Follow-up Period. Angiology 2021; 73:407-412. [PMID: 34617824 DOI: 10.1177/00033197211043406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
We assessed the clinical outcomes of patients with critical limb-threatening ischemia (CLTI) who underwent interwoven nitinol stent (Supera) implantation for significant stenoses of the femoropopliteal segment. In this retrospective cohort study, 116 consecutive patients with CLTI who were treated with Supera stents between September 2015 and March 2020 were included in this analysis. Primary endpoint analysis was completed for amputation-free survival, target lesion revascularization (TLR), and mortality. After a mean follow-up time of 3.4 years, 21 (18%) patients had undergone amputations, 3 (2.6%) died, and, overall, the amputation-free survival rate was 81%. TLR occurred in 21 (18%) patients, resulting in the freedom from target lesion revascularization of 82%. The average Wagner score for all patients was 2.8 ± 1.1. A subgroup analysis of 57 patients revealed a median ulcer size of 3.0 cm2 [1.65, 9.0], with complete healing for 45 patients by 20 months. The Wagner score of this subgroup decreased by an average of 3.4 ± .9 points. Supera stents can be used together with other endovascular therapies and are a safe and effective treatment modality for CLTI.
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Affiliation(s)
- Prakash Krishnan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Tarricone
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Gee
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serdar Farhan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon Kamran
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Kapur
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karthik Gujja
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Faries CM, Rao A, Ilonzo N, Hwong S, Krishnan P, Farhan S, Ting W, Vouyouka AG, Tadros RO, Marin ML, Faries PL. Follow-up after acute thrombotic events following COVID-19 infection. J Vasc Surg 2021; 75:408-415.e1. [PMID: 34597784 PMCID: PMC8504991 DOI: 10.1016/j.jvs.2021.08.092] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
Objective COVID-19 infection results in a hypercoagulable state predisposing patients to thrombotic events. We report the 3- and 6-month follow-up of 27 patients who experienced acute arterial thrombotic events in the setting of COVID-19 infection. Methods Data were prospectively collected and maintained for all vascular surgery consultations in the Mount Sinai Health System from patients who presented between March 16 and May 5, 2020. Results Twenty-seven patients experienced arterial thrombotic events. The average length of stay was 13.3 ± 15.4 days. Fourteen patients were treated with open surgical intervention, six were treated with endovascular intervention, and seven were treated with anticoagulation only. At 3-month follow-up, 11 patients (40.7%) were deceased. Nine patients who expired did so during the initial hospital stay. The 3-month cumulative primary patency rate for all interventions was 72.2%, and the 3-month primary patency rates for open surgical and endovascular interventions were 66.7 and 83.3, respectively. There were 9 (33.3%) readmissions within 3 months. Six-month follow-up was available in 25 (92.6%) patients. At 6-month follow-up, 12 (48.0%) patients were deceased, and the cumulative primary patency rate was 61.9%. The 6-month primary patency rates of open surgical and endovascular interventions were 66.7% and 55.6%, respectively. The limb-salvage rate at both 3 and 6 months was 89.2%. Conclusions Patients with COVID-19 infections who experienced thrombotic events saw high complication and mortality rates with relatively low patency rates.
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Affiliation(s)
| | - Ajit Rao
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Nicole Ilonzo
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Songhon Hwong
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Prakash Krishnan
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Serdar Farhan
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | | | - Rami O Tadros
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Michael L Marin
- Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Peter L Faries
- Department of Surgery, Division of Vascular Surgery, New York, NY
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Hauguel-Moreau M, Barthélémy O, Farhan S, Huber K, Rouanet S, Zeitouni M, Guedeney P, Hage G, Vicaut E, Zeymer U, Desch S, Thiele H, Montalescot G. Culprit lesion location and outcomes in patients with multivessel disease and infarct-related cardiogenic shock: a core laboratory analysis of the CULPRIT-SHOCK trial. EUROINTERVENTION 2021; 17:e418-e424. [PMID: 32894227 PMCID: PMC9725066 DOI: 10.4244/eij-d-20-00561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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 Critical culprit lesion locations (CCLL) such as left main (LM) and proximal left anterior descending (LAD) are associated with worse clinical outcome in myocardial infarction without cardiogenic shock (CS). AIMS We aimed to assess whether CCLL identify a subgroup of patients with poorer prognosis when presenting with CS. METHODS In the CULPRIT-SHOCK trial, a core laboratory reviewed all coronary angiograms to identify CCLL. A CCLL was defined as a culprit lesion with a >70% diameter stenosis of the LM, LM equivalent (>70% diameter stenosis of both proximal LAD and proximal circumflex), proximal LAD or last remaining vessel. We evaluated the primary study endpoint of the CULPRIT-SHOCK trial according to CCLL. RESULTS A total of 269 (43%) out of 626 patients eligible for this analysis had a CCLL. Death or renal replacement therapy within 30 days, death within 30 days and death within one year were significantly higher in the CCLL than in the non-CCLL group (58.4% vs 43.4%, p<0.001, 55.8% vs 39.5%, p<0.001, 61.0% vs 44.5%, p<0.001, respectively). This was consistent after adjustment for baseline and angiographic characteristics. No interaction with the randomisation group (culprit lesion-only or immediate multivessel PCI) was found. CONCLUSIONS CCLL is frequent in CS and independently associated with worse clinical outcomes irrespective of the revascularisation strategy. TRIAL REGISTRATION www.clinicaltrials.gov NCT01927549.
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Affiliation(s)
- Marie Hauguel-Moreau
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Olvier Barthélémy
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital and Sigmund Freund University, Medical School, Vienna, Austria
| | | | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Georges Hage
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (Ap-HP), Paris, France
| | - Uwe Zeymer
- Heart Centre Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany
| | - Steffen Desch
- Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
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Avadhani SA, Kamran H, Farhan S, Tarricone A, Krishnan P. Aneurysmal Dilatation of the Superficial Femoral Artery After Endovascular Intervention. JACC Case Rep 2021; 3:425-426. [PMID: 34317550 PMCID: PMC8311142 DOI: 10.1016/j.jaccas.2021.01.028] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
A patient with occlusion of the left superficial femoral artery (SFA) underwent endovascular intervention. Six-month follow-up angiography revealed aneurysmal dilatation of the previously stented artery. This finding may be a result of maladaptive vascular remodeling or arterial injury resulting in aneurysmal dilatation secondary to subintimal crossing, atherectomy, and paclitaxel therapies. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Sriya A Avadhani
- Mount Sinai Heart, Mount Sinai Medical Center, New York, New York, USA
| | - Haroon Kamran
- Mount Sinai Heart, Mount Sinai Medical Center, New York, New York, USA
| | - Serdar Farhan
- Mount Sinai Heart, Mount Sinai Medical Center, New York, New York, USA
| | - Arthur Tarricone
- Mount Sinai Heart, Mount Sinai Medical Center, New York, New York, USA
| | - Prakash Krishnan
- Mount Sinai Heart, Mount Sinai Medical Center, New York, New York, USA
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Hemetsberger R, Farhan S, Lukovic D, Zlabinger K, Hajagos-Toth J, Bota J, Garcia-Garcia HM, Ay C, Samaha E, Gaspar R, Garamvölgyi R, Huber K, Gyöngyösi M, Spannbauer A. Peri-interventional Triple Therapy With Dabigatran Improves Vasomotion and Promotes Endothelialization in Porcine Coronary Stenting Model. Front Cardiovasc Med 2021; 8:690476. [PMID: 34307502 PMCID: PMC8300015 DOI: 10.3389/fcvm.2021.690476] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: We evaluated the short and long-term effect of peri-interventional dabigatran therapy on vasomotion, endothelialization, and neointimal formation in a porcine coronary artery stenting model. Background: Stenting of coronary arteries induces local inflammation, impairs vasomotion and delays endothelialization. Methods: Twenty-eight animals underwent percutaneous coronary intervention (PCI) with drug eluting stents. Sixteen pigs started dabigatran therapy 4 days prior to PCI and continued for 4 days post-stenting, while 12 animals served as controls. Post-stenting dual antiplatelet therapy (75 mg clopidogrel and 100 mg aspirin) was continued in both groups until termination. Immediately post-stenting and at day 3 optical coherence tomography (OCT) was performed in all animals, followed by euthanasia of 8 dabigatran and 4 control animals. The remaining pigs (8 of each group) were followed up for 1 month, with control angiography and OCT. Tissue burden (degree of peri-strut structure—thrombus and/or fibrin) was evaluated. After euthanasia coronary arteries were harvested for in-vitro myometry and histology. Results: Thrombin generation was lower (p < 0.001) and tissue burden (0.83 ± 0.98 vs. 3.0 ± 2.45; p = 0.031) was significantly decreased in dabigatran treated animals. After 3 days post-PCI endothelium-dependent vasodilation was significantly improved (77 ± 40% vs. 41 ± 31%, p = 0.02) in dabigatran animals. Neither quantitative angiography nor histomorphometry showed differences between the groups. Endothelialization was faster in the dabigatran group as compared with controls (p = 0.045). Conclusion: Short-term peri-interventional triple therapy with dabigatran, aspirin, and clopidogrel led to an enhanced endothelium dependent vasodilation and faster endothelialization. However, neointimal formation 1-month after stent implantation was comparable between groups.
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Affiliation(s)
- Rayyan Hemetsberger
- Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Serdar Farhan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dominika Lukovic
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Katrin Zlabinger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Judit Hajagos-Toth
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Judit Bota
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | | | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eslam Samaha
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Robert Gaspar
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Rita Garamvölgyi
- Institute of Diagnostics and Radiation Oncology, University of Kaposvár, Kaposvár, Hungary
| | - Kurt Huber
- 3rd Medical Department of Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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Kamran H, Malhotra R, Farhan S, Masoomi R, Garg A, Hooda A, Lascano R, Han D, Tadros R, Tarricone A, Baber U, Mehran R, Huber K, Krishnan P. Meta-Analysis of Anticoagulation Therapy for the Prevention of Cardiovascular Events in Patients With Peripheral Arterial Disease. Am J Cardiol 2021; 148:165-171. [PMID: 33667437 DOI: 10.1016/j.amjcard.2021.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Peripheral artery disease (PAD) remains a major cause of morbidity and future cardiovascular events despite advancement in the surgical interventions and optimal medical therapy. The aim of our study is to evaluate the efficacy and safety of anticoagulation (AC) therapy for reducing cardiovascular and limb events in patients with PAD. PUBMED, Medline, and Cochrane Library were searched through 2020 for randomized clinical trials comparing major adverse cardiovascular events (MACE) and risk of major bleeding (MB), between AC and standard of care (SOC) therapy, among patients with PAD. Meta-analysis was performed using weighted pooled absolute risk difference (RD) with 95% confidence interval (CI) and fixed effects model for overall and sub-groups of full dose (FD) and low dose (LD) AC therapies. Amongst 17,684 patients from 7 different studies, the addition of AC to SOC therapy was associated with MACE reduction (RD -0.022, 95% CI -0.033 to -0.012, p <0.001) and increased MB (RD 0.02, 95% CI 0.014 to 0.025, p <0.001). For FD, MACE reduction was (RD -0.021, 95% CI -0.042 to 0.001, p = 0.061) and MB (RD 0.036, 95% CI 0.025 to 0.047, p <0.001). For LD, MACE reduction was (RD -0.023, 95% CI -0.035 to -0.011, p <0.001) and MB (RD 0.011, 95% CI 0.005 to 0.017, p <0.001). In conclusion, addition of AC to the current SOC therapy can mitigate future MACE events in patients with PAD albeit at risk of increased bleeding. LD AC is associated with an efficacy/safety net benefit compared to FD AC therapy.
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Azzalini L, Baber U, Johal GS, Farhan S, Barman N, Kapur V, Hasan C, Vijay P, Jhaveri V, Mehran R, Kini AS, Sharma SK. One-year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug-eluting stents. Catheter Cardiovasc Interv 2021; 97:1341-1351. [PMID: 32478459 DOI: 10.1002/ccd.28996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI). BACKGROUND It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES). METHODS Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. RESULTS We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. CONCLUSIONS We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.
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Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gurpreet S Johal
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Kapur
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Choudhury Hasan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pooja Vijay
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vaishvi Jhaveri
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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39
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Vogel B, Baber U, Cohen DJ, Sartori S, Sharma SK, Angiolillo DJ, Farhan S, Goel R, Zhang Z, Briguori C, Collier T, Dangas G, Dudek D, Escaned J, Gil R, Han YL, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta SR, Moliterno D, Ohman EM, Sardella G, Witzenbichler B, Gibson CM, Pocock S, Huber K, Mehran R. Sex Differences Among Patients With High Risk Receiving Ticagrelor With or Without Aspirin After Percutaneous Coronary Intervention: A Subgroup Analysis of the TWILIGHT Randomized Clinical Trial. JAMA Cardiol 2021; 6:1032-1041. [PMID: 33991416 DOI: 10.1001/jamacardio.2021.1720] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Shortened dual antiplatelet therapy followed by potent P2Y12 receptor inhibitor monotherapy reduces bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). Objective To explore sex differences and evaluate the association of sex with outcomes among patients treated with ticagrelor monotherapy vs ticagrelor plus aspirin. Design, Setting, and Participants This was a prespecified secondary analysis of TWILIGHT, an investigator-initiated, placebo-controlled randomized clinical trial conducted at 187 sites across 11 countries. Study participants included patients who underwent successful PCI with drug-eluting stents, were planned for discharge with ticagrelor plus aspirin, and who had at least 1 clinical and at least 1 angiographic feature associated with high risk of ischemic or bleeding events. Data were analyzed from May to July 2020. Interventions At 3 months after PCI, patients adherent to ticagrelor and aspirin without major adverse event were randomized to either aspirin or placebo for an additional 12 months along with ticagrelor. Main Outcomes and Measures The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding at 12 months after randomization. The primary ischemic end point was a composite of death, myocardial infarction, or stroke. Results Of 9006 enrolled patients, 7119 underwent randomization (mean [SD] age, 63.9 [10.2] years; 5421 [76.1%] men). Women were older (mean [SD] age, 65.5 [9.6] years in women vs 63.4 [10.3] years in men) with higher prevalence of chronic kidney disease (347 women [21.2%] vs 764 men [14.7%]). The primary bleeding end point occurred more often in women than men (hazard ratio [HR], 1.32; 95% CI, 1.06-1.64; P = .01). After multivariate adjustment, incremental bleeding risk associated with female sex was no longer significant (adjusted HR, 1.20; 95% CI, 0.95-1.52; P = .12). Ischemic end points were similar between sexes. Ticagrelor plus placebo vs ticagrelor plus aspirin was associated with lower risk of BARC type 2, 3, or 5 bleeding in women (adjusted HR, 0.62; 95% CI, 0.42-0.92; P = .02) and men (adjusted HR, 0.57; 95% CI, 0.44-0.73; P < .001; P for interaction = .69). Ischemic end points were similar between treatment groups in both sexes. Conclusions and Relevance These findings suggest that the higher bleeding risk in women compared with men was mostly attributable to baseline differences, whereas ischemic events were similar between sexes. In this high-risk PCI population, the benefits of early aspirin withdrawal with continuation of ticagrelor were generally comparable in women and men. Trial Registration ClinicalTrials.gov Identifier: NCT02270242.
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Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City
| | - David J Cohen
- St Francis Hospital, Roslyn, New York.,Cardiovascular Research Foundation, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Javier Escaned
- Department of Cardiology, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Calle del Prof Martin Lagos, Madrid, Spain
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Sheng, China
| | - Upendra Kaul
- Department of Cardiology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Mitchell W Krucoff
- Department of Cardiology, Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Shamir R Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, Canada
| | | | - E Magnus Ohman
- Department of Cardiology, Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I University, Roma, Italy
| | | | - C Michael Gibson
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kurt Huber
- Department of Cardiology, Wilhelminenhospital, Vienna, Austria.,Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Farhan S, Kamran H, Vogel B, Garg K, Rao A, Narula N, Jacobowitz G, Tarricone A, Kapur V, Faries P, Marin M, Narula J, Lookstein R, Olin JW, Krishnan P. Considerations for Patients With Peripheral Artery Disease During the COVID-19 Pandemic. Clin Appl Thromb Hemost 2021; 27:1076029620986877. [PMID: 33783244 PMCID: PMC8013533 DOI: 10.1177/1076029620986877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
New York City was one of the epicenters of the COVID-19 pandemic. The management of peripheral artery disease (PAD) during this time has been a major challenge for health care systems and medical personnel. This document is based on the experiences of experts from various medical fields involved in the treatment of patients with PAD practicing in hospitals across New York City during the outbreak. The recommendations are based on certain aspects including the COVID-19 infection status as well as the clinical PAD presentation of the patient. Our case-based algorithm aims at guiding the treatment of patients with PAD during the pandemic in a safe and efficient way.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon Kamran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karan Garg
- 5894New York University Grossman School of Medicine, NY, USA
| | - Ajit Rao
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Navneet Narula
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Glenn Jacobowitz
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Tarricone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Kapur
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Faries CM, Rao A, Ilonzo N, Hwang S, Krishnan P, Farhan S, Ting W, Lantis J, Marin ML, Faries PL. Acute Thrombotic Event From Covid-19 Infection: Short-term Follow-up. Ann Vasc Surg 2021. [PMCID: PMC7889006 DOI: 10.1016/j.avsg.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farhan S, Redfors B, Maehara A, McAndrew T, Ben-Yehuda O, De Bruyne B, Mehran R, Vogel B, Giustino G, Serruys PW, Mintz GS, Stone GW. Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study. Cardiovasc Diabetol 2021; 20:10. [PMID: 33413366 PMCID: PMC7791845 DOI: 10.1186/s12933-020-01207-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background We investigated the association of insulin resistance (IR) with coronary plaque morphology and the risk of cardiovascular events in patients enrolled in the Providing Regional Observations to Study Predictors of Events in Coronary Tree (PROSPECT) study. Methods Patients with acute coronary syndromes (ACS) were divided based on DM status. Non-DM patients were further stratified according to homeostasis-model-assessment IR (HOMA-IR) index as insulin sensitive (IS; HOMA-IR ≤ 2), likely-IR (LIR; 2 < HOMA-IR < 5), or diabetic-IR (DIR; HOMA-IR ≥ 5). Coronary plaque characteristics were investigated by intravascular ultrasound. The primary endpoint was major adverse cardiac events (MACE); a composite of cardiac death, cardiac arrest, myocardial infarction, and rehospitalization for unstable/progressive angina. Results Among non-diabetic patients, 109 patients (21.5%) were categorized as LIR, and 65 patients (12.8%) as DIR. Patients with DIR or DM had significantly higher rates of echolucent plaque compared with LIR and IS. In addition, DIR and DM were independently associated with increased risk of MACE compared with IS (adjusted hazard ratio [aHR] 2.29, 95% confidence interval [CI] 1.22–4.29, p = 0.01 and aHR 2.12, 95% CI 1.19–3.75, p = 0.009, respectively). Conclusions IR is common among patients with ACS. DM and advanced but not early stages of IR are independently associated with increased risk of adverse cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT00180466.
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Affiliation(s)
- Serdar Farhan
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. .,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Roxana Mehran
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Birgit Vogel
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Gennaro Giustino
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Patrick W Serruys
- Department of Cardiology, NUIG, National University of Ireland, Galway, Ireland.,Imperial College of Science, Technology and Medicine, London, UK
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Gregg W Stone
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
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Farhan S, Vogel B, Montalescot G, Barthelemy O, Zeymer U, Desch S, de Waha-Thiele S, Maier LS, Sandri M, Akin I, Fuernau G, Ouarrak T, Hauguel-Moreau M, Schneider S, Thiele H, Huber K. Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Cardiol 2020; 5:1329-1337. [PMID: 32845312 DOI: 10.1001/jamacardio.2020.3377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Myocardial infarction with a culprit lesion located in the left main or proximal left anterior descending artery compared with other coronary segments is associated with more myocardium at risk and worse clinical outcomes. Objective To evaluate the association of culprit lesion location with outcomes of culprit-lesion-only percutaneous coronary intervention with optional staged revascularization vs immediate multivessel percutaneous coronary intervention in patients with multivessel disease, myocardial infarction, and cardiogenic shock. Design, Setting, and Participants Post hoc analysis of the Culprit Lesion Only Coronary Intervention vs Multivessel Coronary Intervention in Cardiogenic Shock (CULPRIT-SHOCK), an investigator-initiated randomized, open-label clinical trial. Patients with multivessel disease, acute myocardial infarction, and cardiogenic shock were enrolled at 83 European centers from April 2013 through April 2017. Interventions Patients were randomized to culprit-lesion-only percutaneous coronary intervention with optional staged revascularization or immediate multivessel percutaneous coronary intervention (1:1). For this analysis, patients were stratified by culprit lesion location in the left main or proximal left anterior descending artery group and other-culprit-lesion location group. Main Outcomes and Measures End points included a composite of death or kidney replacement therapy at 30 days and death at 1 year. Results The median age of the study population was 70 (interquartile range, 60-78 years) and 524 of the study participants were men (76.4%). Of the 685 patients, 33.4% constituted the left main or proximal left anterior descending artery group and 66.6% the other-culprit-lesion location group. The left main or proximal left anterior descending artery group had worse outcomes compared with the other-culprit-lesion location group (56.8% vs 47.5%; P = .02 for the composite end point at 30 days and 59.8% vs 50.1%; P = .02 for death at 1 year). In both groups, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a reduced risk of the composite end point at 30 days (49.1% vs 64.3% and 44.1% vs 50.9%; P for interaction = .27). At 1 year, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a significantly reduced risk of death in the left main or proximal left anterior descending artery but not the other-culprit-lesion location group (50.0% vs 69.6%; P = .003 and 49.8% vs 50.4%; P = .89; P for interaction = 0.02). Conclusions and Relevance In patients with multivessel disease with myocardial infarction and cardiogenic shock, a culprit lesion located in the left main or proximal left anterior descending artery vs other coronary segments was associated with worse outcomes. These patients may especially benefit from culprit-lesion-only percutaneous coronary intervention with optional staged revascularization, although further investigation is needed to confirm this finding. Trial Registration ClinicalTrials.gov Identifier: NCT01927549.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Wilhelminenspital, Department of Cardiology, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Wilhelminenspital, Department of Cardiology, Vienna, Austria
| | - Gilles Montalescot
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | - Olivier Barthelemy
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany
| | - Lars S Maier
- Department of Cardiology, Pneumology, and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ibrahim Akin
- University Medical Centre Mannheim, First Department of Medicine, Faculty of Medicine, University of Heidelberg, Mannheim, Germany
| | - Georg Fuernau
- Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany
| | | | - Marie Hauguel-Moreau
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Kurt Huber
- Wilhelminenspital, Department of Cardiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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Armario X, Rosseel L, Kharbanda R, Khogali S, Abdel-Wahab M, Van Mieghem NM, Tchétché D, Dumonteil N, De Backer O, Cotton J, McGrath B, Balakrishnan D, Ali N, Farhan S, Joseph J, Charbonnier G, Okuno T, McHugh F, Hildick-Smith D, Gilgen N, Hokken T, Spence MS, Frerker C, Angelillis M, Grygier M, Cockburn J, Bjursten H, Jeger RV, Teles R, Petronio AS, Pilgrim T, Sinning JM, Nickenig G, Søndergaard L, Blackman DJ, Mylotte D. Transcatheter Aortic Valve Replacement With the LOTUS Edge System: Early European Experience. JACC Cardiovasc Interv 2020; 14:172-181. [PMID: 33478633 DOI: 10.1016/j.jcin.2020.09.044] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system. BACKGROUND The LOTUS Edge system was commercially re-released in April 2019. The authors report the first European experience with this device. METHODS A multicenter, single-arm, retrospective registry was initiated to evaluate short-term clinical outcomes. Included cases are the first experience with this device and new implantation technique in Europe. Clinical, echocardiographic, and computed tomographic data were analyzed. Endpoints were defined according to Valve Academic Research Consortium-2 and were site reported. RESULTS Between April and November 2019, 286 consecutive patients undergoing TAVR with the LOTUS Edge system at 18 European centers were included. The mean age and Society of Thoracic Surgeons score were 81.2 ± 6.9 years and 5.2 ± 5.4%, respectively. Nearly one-half of all patients (47.9%) were considered to have complex anatomy. Thirty-day major adverse events included death (2.4% [n = 7]) and stroke (3.5% [n = 10]). After TAVR, the mean aortic valve area was 1.9 ± 0.9 cm2, and the mean transvalvular gradient was 11.9 ± 5.7 mm Hg. None or trace paravalvular leak (PVL) occurred in 84.4% and moderate PVL in 2.0%. There were no cases of severe PVL. New permanent pacemaker (PPM) implantation was required in 25.9% among all patients and 30.8% among PPM-naive patients. CONCLUSIONS Early experience with the LOTUS Edge system demonstrated satisfactory short-term safety and efficacy, favorable hemodynamic data, and very low rates of PVL in an anatomically complex cohort. New PPM implantation remained high. Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of PPM implantation.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Rajesh Kharbanda
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - James Cotton
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Brian McGrath
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Deepu Balakrishnan
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Noman Ali
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Serdar Farhan
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Jubin Joseph
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Taishi Okuno
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Fiachra McHugh
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thijmen Hokken
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Mark S Spence
- Department of Cardiology, Belfast City Hospital Trust, Belfast, United Kingdom
| | - Christian Frerker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marco Angelillis
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - James Cockburn
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rui Teles
- Department of Interventional Cardiology, UNICARV, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Anna S Petronio
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | | | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; National University of Ireland Galway, Galway, Ireland.
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Baber U, Zafar MU, Dangas G, Escolar G, Angiolillo DJ, Sharma SK, Kini AS, Sartori S, Joyce L, Vogel B, Farhan S, Gurbel P, Gibson CM, Fuster V, Mehran R, Badimon JJ. Ticagrelor With or Without Aspirin After PCI: The TWILIGHT Platelet Substudy. J Am Coll Cardiol 2020; 75:578-586. [PMID: 32057371 DOI: 10.1016/j.jacc.2019.11.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND An evolving strategy in the setting of percutaneous coronary intervention (PCI) involves withdrawal of acetylsalicylic acid (ASA), or aspirin, while maintaining P2Y12 inhibition. However, the pharmacodynamic effects of this approach on blood thrombogenicity and platelet reactivity remain unknown. OBJECTIVES This study sought to compare the antithrombotic potency of ticagrelor alone versus ticagrelor plus ASA among high-risk patients undergoing PCI with drug-eluting stents. METHODS This was a mechanistic substudy within the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, which randomized patients undergoing PCI to ticagrelor plus placebo versus ticagrelor plus ASA following 3 months of dual antiplatelet therapy. Substudy participants were enrolled after randomization, at which time ex vivo assays to quantify thrombus size under dynamic flow conditions and platelet reactivity were performed. Pharmacodynamic assessments were repeated 1 to 6 months thereafter. The primary endpoint was thrombus size at the post-randomization visit with platelet reactivity following stimuli to arachidonic acid, collagen, adenosine diphosphate, and thrombin as secondary endpoints. Results were analyzed using analysis of covariance. RESULTS A total of 51 patients were enrolled, among whom 42 underwent perfusion assays at baseline and follow-up with a median time between studies of 1.5 months. The adjusted mean difference in post-randomization thrombus area was similar between groups: -218.2 μm2 (95% confidence interval [CI]: -575.9 to 139.9 μm2; p = 0.22). Markers sensitive to cyclo-oxygenase-1 blockade, including platelet reactivity in response to arachidonic acid (mean difference: 10.9 U; 95% CI: 1.9 to 19.9 U) and collagen (mean difference: 9.8 U; 95% CI: 0.8 to 18.8 U) stimuli were higher among patients receiving placebo, whereas levels of platelet reactivity were similar with adenosine diphosphate and thrombin. CONCLUSIONS Among high-risk patients receiving drug-eluting stents, the antithrombotic potency of ticagrelor monotherapy is similar to that of ticagrelor plus ASA with respect to ex vivo blood thrombogenicity, whereas markers sensitive to cyclo-oxygenase-1 blockade are increased in the absence of ASA. (Platelet Substudy of the TWILIGHT Trial; NCT04001374).
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Affiliation(s)
- Usman Baber
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Urooj Zafar
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ginés Escolar
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Samin K Sharma
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Joyce
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Birgit Vogel
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul Gurbel
- Inova Center for Thrombosis Research and Translational Medicine, Falls Church, Virginia
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
| | - Valentin Fuster
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Juan J Badimon
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, New York
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Tscharre M, Herman R, Rohla M, Hauser C, Farhan S, Freynhofer MK, Huber K, Weiss TW. Corrigendum to “Uric acid is associated with long-term adverse cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention” [Atherosclerosis 270 (2018) 173–179]. Atherosclerosis 2020; 306:96. [DOI: 10.1016/j.atherosclerosis.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Guedeney P, Claessen BE, Mehran R, Mintz GS, Liu M, Sorrentino S, Giustino G, Farhan S, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ali ZA, Généreux P, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW. Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation. JACC Cardiovasc Interv 2020; 13:1417-1428. [DOI: 10.1016/j.jcin.2020.03.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
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Guedeney P, Claessen BE, Kalkman DN, Aquino M, Sorrentino S, Giustino G, Farhan S, Vogel B, Sartori S, Montalescot G, Sweeny J, Kovacic JC, Krishnan P, Barman N, Dangas G, Kini A, Baber U, Sharma S, Mehran R. Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2020; 73:2401-2409. [PMID: 31097159 DOI: 10.1016/j.jacc.2019.01.077] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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: 01/09/2019] [Accepted: 01/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data on the impact of residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl are scarce. OBJECTIVES The purpose of this study was to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl. METHODS All patients undergoing PCI between January 2009 and December 2016 in a single tertiary center, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least 2 measurements ≥4 weeks apart) were retrospectively analyzed. High RIR was defined as hsCRP >2 mg/l. Patients were categorized as persistent low RIR (first low then low hsCRP), attenuated RIR (first high then low hsCRP), increased RIR (first low then high hsCRP), or persistent high RIR (first high then high hsCRP). Primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement. RESULTS A total of 3,013 patients were included, with persistent low, attenuated, increased, and persistent high RIR in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively. Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years; p < 0.001). After adjustment, the presence of persistent high RIR remained strongly associated with MACCE (adjusted hazard ratio: 2.10; 95% confidence interval: 1.45 to 3.02; p < 0.001). CONCLUSIONS Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.
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Affiliation(s)
- Paul Guedeney
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York; Sorbonne Université, ACTION Study Group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Bimmer E Claessen
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Deborah N Kalkman
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York; Amsterdam UMC, University of Amsterdam, Heart Center, and the Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Melissa Aquino
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Sabato Sorrentino
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Gennaro Giustino
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | | | | | | | | | - George Dangas
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | | | - Usman Baber
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
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Rizas K, Farhan S, Huczek Z, Merkely B, Hein-Rothweiler R, Vogel B, Massberg S, Huber K, Aradi D, Sibbing D. 3293Atherothrombotic risk and outcomes following guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome:a post-hoc analysis of the TROPICAL-ACS trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0058] [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
A de-escalation of P2Y12-inhibitor treatment guided by platelet function testing (PFT) has been identified as a safe and alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, no specific data are available on the efficacy of such strategy in patients with high atherothrombotic risk (ATR).
Purpose
To investigate the safety and efficacy of guided de-escalation of P2Y12-inhibitor treatment in patients with low- vs. high-ATR.
Methods
The TROPICAL-ACS trial randomized 2,610 biomarker-positive ACS patients 1:1 to either conventional treatment with prasugrel for 12 months (control group) or to a PFT guided de-escalation treatment strategy (guided de-escalation group). The primary endpoint was defined as the composite of cardiovascular mortality (CVM), myocardial infarction (MI), stroke, and clinically overt bleeding (bleeding ≥ grade 2 according to the BARC criteria). The ischemic endpoint was defined as the composite of CVM, MI or stroke. We used semi-parametric Cox regression analysis and interaction testing to assess the effect of low- vs. high-ATR on the primary and ischemic endpoints. High-ATR was defined as one of the following: (i) age ≥65 years or (ii) age <65 and either history of peripheral artery disease or at least two of the following risk-factors: diabetes mellitus, current smoking or renal dysfunction.
Results
Patients with high- (n=990) versus low-ATR (n=1,620) exhibited a higher risk for the primary endpoint (11.0% vs. 6.7%; HR 1.67; 95% CI 1.28–2.18; p<0.001). Guided de-escalation was non-inferior to conventional treatment for the primary endpoint in both patients with high- (10.5% vs. 11.5%; pnon-inferiority = 0.029; Figure 1A) and low-ATR (5.6% vs. 7.7%; pnon-inferiority=0.001; Figure 1B). Moreover, there was no significant interaction in the prognostic value of guided de-escalation between high- and low-ATR groups for both the primary (HR 0.90 [0.61–1.32]; p=0.586 in patients with high-ART vs. 0.71 [0.48–1.04; p=0.082 in patients with low-ATR; pinteraction= 0.394) and combined ischemic endpoints (HR 0.83 [0.44–1.56]; p=0.567 in patients with high-ATR vs. 0.68 [0.35–1.34]; p=0.262 in patients with low-ATR; pinteraction =0.666).
Kaplan-Meier curves
Conclusion
A guided DAPT de-escalation strategy appears to be safe and effective in ACS patients regardless of the atherothrombotic risk. Further studies are needed for refining antiplatelet treatment strategies in ACS patients with varying levels of atherothrombotic risk.
Acknowledgement/Funding
Klinikum der Universität München, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo.
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Affiliation(s)
- K Rizas
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - S Farhan
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - R Hein-Rothweiler
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - B Vogel
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - S Massberg
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - K Huber
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - D Sibbing
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
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50
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Guedeney P, Claessen B, Mehran R, Mintz G, Liu M, Sorrentino S, Farhan S, Leon MB, Serruys P, Smits PC, Von Birgelen C, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW. P1966Impact of coronary artery calcification on long-term outcomes after implantation of first and second-generation drug-eluting stents: a patient-level analysis of 18 randomized trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0712] [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
Available data on the long-term impact of coronary artery calcification (CAC) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) are limited.
Purpose
We evaluated the long-term impact of CAC on outcomes after PCI and the respective performance of first- and second-generation DES.
Methods
We pooled patient-level data from 18 randomized trials evaluating DES categorized according to the presence of angiographic core lab-confirmed moderate or severe CAC in any target lesion. Outcome measures of interest were the patient-oriented composite endpoint (POCE; death, myocardial infarction [MI], or any revascularization), the device-oriented composite endpoint of target lesion failure (TLF; cardiac death, target vessel MI or ischemia-driven target lesion revascularization), and definite or probable stent thrombosis (ST). Multivariable Cox proportional regression with study as a random effect was used to assess 5-year outcomes.
Results
A total of 19,833 patients were included. Moderate or severe CAC was present in 6211 (31.3%) patients and associated with increased 5-year risk of the POCE (adjHR 1.12, 95% CI 1.05–1.20, p<0.001), TLF (adjHR 1.21, 95% CI 1.09–1.35, p<0.001), and a trend for greater ST (adjHR 1.24, 95% CI 0.99–1.54, p=0.06). In patients with CAC, second-generation DES were associated with a reduction in the 5-year risk of TLF and ST, and a trend for reduced POCE compared with first-generation DES (Table).
Conclusion
In this large-scale study, target lesion moderate or severe CAC was associated with adverse patient- and device-related outcomes at 5 years, risks that were reduced but not eliminated with second-generation DES.
Acknowledgement/Funding
This investigator-sponsored study was funded by Abbott Vascular.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - B Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - G Mintz
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - M Liu
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - S Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - S Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - M B Leon
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - P Serruys
- Imperial College London, Technology and medicine, London, United Kingdom
| | - P C Smits
- Maasstad Ziekenhuis, Cardiology, Rotterdam, Netherlands (The)
| | - C Von Birgelen
- Medical Spectrum Twente, Cardiology, Enschede, Netherlands (The)
| | - B Redfors
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - M V Madhavan
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - O Ben-Yehuda
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
| | - G W Stone
- Cardiovascular Research Foundation, Clinical trials center, New York, United States of America
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