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Chandrasekhar J, Baber U, Sartori S, Goel R, Nicolas J, Vogel B, Snyder C, Kini A, Briguori C, Witzenbichler B, Iakovou I, Sardella G, Marzo K, DeFranco A, Stuckey T, Chieffo A, Colombo A, Shlofmitz R, Capodanno D, Dangas G, Pocock S, Mehran R. Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: primary results from the AVIATOR 2 international registry. EUROINTERVENTION 2022; 18:e656-e665. [PMID: 35656720 PMCID: PMC10241278 DOI: 10.4244/eij-d-21-01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/06/2022] [Indexed: 10/09/2023]
Abstract
BACKGROUND Managing percutaneous coronary intervention (PCI) patients with atrial fibrillation (AF) presents challenges given that there are several potential antithrombotic therapy (ATT) strategies. AIMS We examined ATT patterns, agreement between subjective physician ratings and validated risk scores, physician-patient perceptions influencing ATT and 1-year outcomes. METHODS The AVIATOR 2 prospective registry enrolled 514 non-valvular AF-PCI patients from 11 sites. Treating physicians selected ATT and completed smartphone surveys rating stroke and bleeding risks, compared against CHA2DS2-VASc and HAS-BLED scores. Patients completed surveys regarding treatment understanding. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, definite/probable stent thrombosis, stroke, target lesion revascularisation) and actionable bleeding (Bleeding Academic Research Consortium 2, 3 or 5). RESULTS The mean patient age was 73.2±9.0 years, including 25.8% females. Triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 66.5%, dual antiplatelet therapy (DAPT) in 20.7% and dual therapy (1 anticoagulant+1 antiplatelet agent) in 12.8% of patients. Physician ratings and validated risk scores showed poor agreement (stroke: kappa=0.03; bleeding: kappa=0.07). Physicians rated bleeding-related safety (93.8%) as the main factor affecting ATT choice. Patients worried about stroke over bleeding (50.6% vs 14.8%). No group differences by ATT strategy were observed in 1-year MACCE (TT 14.1% vs dual therapy 12.7% vs DAPT 18.5%; p=0.25), or actionable bleeding (14.7% vs 7.9% vs 15.1%, respectively; p=0.89). CONCLUSIONS The AVIATOR 2 study is the first digital health study examining physician-patient perspectives on ATT choices after AF-PCI. TT was the most common strategy without differences in 1-year outcomes in ATT strategy. Physicians rated safety first when prescribing ATT; patients feared stroke over bleeding. CLINICALTRIALS gov: NCT02362659.
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Affiliation(s)
- Jaya Chandrasekhar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Box Hill Hospital, Eastern Health Clinical School and Monash University, Melbourne, Australia
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Ridhima Goel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- State University of New York, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Johny Nicolas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clayton Snyder
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Kevin Marzo
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | | | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy and IRCCS Humanitas Research Hospital, Italy
| | | | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Stuckey T, Meine F, McMinn T, Depta JP, Bennett B, McGarry T, Carroll W, Suh D, Steuter JA, Roberts M, Gillins HR, Lange E, Fathieh F, Burton T, Khosousi A, Shadforth I, Sanders WE, Rabbat MG. Development and validation of a machine learned algorithm to IDENTIFY functionally significant coronary artery disease. Front Cardiovasc Med 2022; 9:956147. [PMID: 36119746 PMCID: PMC9481304 DOI: 10.3389/fcvm.2022.956147] [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: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Multiple trials have demonstrated broad performance ranges for tests attempting to detect coronary artery disease. The most common test, SPECT, requires capital-intensive equipment, the use of radionuclides, induction of stress, and time off work and/or travel. Presented here are the development and clinical validation of an office-based machine learned algorithm to identify functionally significant coronary artery disease without radiation, expensive equipment or induced patient stress. Materials and methods The IDENTIFY trial (NCT03864081) is a prospective, multicenter, non-randomized, selectively blinded, repository study to collect acquired signals paired with subject meta-data, including outcomes, from subjects with symptoms of coronary artery disease. Time synchronized orthogonal voltage gradient and photoplethysmographic signals were collected for 230 seconds from recumbent subjects at rest within seven days of either left heart catheterization or coronary computed tomography angiography. Following machine learning on a proportion of these data (N = 2,522), a final algorithm was selected, along with a pre-specified cut point on the receiver operating characteristic curve for clinical validation. An unseen set of subject signals (N = 965) was used to validate the algorithm. Results At the pre-specified cut point, the sensitivity for detecting functionally significant coronary artery disease was 0.73 (95% CI: 0.68–0.78), and the specificity was 0.68 (0.62–0.74). There exists a point on the receiver operating characteristic curve at which the negative predictive value is the same as coronary computed tomographic angiography, 0.99, assuming a disease incidence of 0.04, yielding sensitivity of 0.89 and specificity of 0.42. Selecting a point at which the positive predictive value is maximized, 0.12, yields sensitivity of 0.39 and specificity of 0.88. Conclusion The performance of the machine learned algorithm presented here is comparable to common tertiary center testing for coronary artery disease. Employing multiple cut points on the receiver operating characteristic curve can yield the negative predictive value of coronary computed tomographic angiography and a positive predictive value approaching that of myocardial perfusion imaging. As such, a system employing this algorithm may address the need for a non-invasive, no radiation, no stress, front line test, and hence offer significant advantages to the patient, their physician, and healthcare system.
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Affiliation(s)
- Thomas Stuckey
- Cone Health Heart and Vascular Center, Greensboro, NC, United States
| | - Frederick Meine
- Novant Health New Hanover Regional Medical Center, Wilmington, NC, United States
| | | | | | | | - Thomas McGarry
- Oklahoma Heart Hospital, Oklahoma City, OK, United States
| | - William Carroll
- Cardiology Associates of North Mississippi, Tupelo, MS, United States
| | - David Suh
- Atlanta Heart Specialists, Atlanta, GA, United States
| | | | | | | | - Emmanuel Lange
- CorVista Health, Inc., Analytics For Life Inc., d.b.a CorVista Health, Toronto, ON, Canada
| | - Farhad Fathieh
- CorVista Health, Inc., Analytics For Life Inc., d.b.a CorVista Health, Toronto, ON, Canada
| | - Timothy Burton
- CorVista Health, Inc., Analytics For Life Inc., d.b.a CorVista Health, Toronto, ON, Canada
| | - Ali Khosousi
- CorVista Health, Inc., Analytics For Life Inc., d.b.a CorVista Health, Toronto, ON, Canada
| | - Ian Shadforth
- CorVista Health, Inc., Washington, DC, United States
- *Correspondence: Ian Shadforth,
| | | | - Mark G. Rabbat
- Loyola University Medical Center, Maywood, IL, United States
- Mark G. Rabbat,
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Stuckey T, Kowalchuk G, Swayampakala K, Gohs F, Kruse K, Bensimhon D. TCT-370 Carolinas Cardiogenic Shock Initiative: 30-Day Outcomes. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1223] [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: 11/24/2022]
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Saleem D, Madhavan M, Redfors B, Stuckey T, Witzenbichler B, Weisz G, Rinaldi M, Liu M, Karmpaliotis D, Kirtane A, Stone G. EFFECT OF HIGH PLATELET REACTIVITY ON ADVERSE EVENTS AFTER PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE: THE ADAPT-DES STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32157-4] [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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Vogel B, Chandrasekhar J, Baber U, Mastoris I, Sartori S, Aquino M, Krucoff MW, Moliterno DJ, Henry TD, Weisz G, Gibson CM, Iakovou I, Kini AS, Farhan S, Sorrentino S, Faggioni M, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen DJ, Stuckey T, Ariti C, Dangas GD, Pocock S, Mehran R. Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry. Thromb Haemost 2019; 119:1704-1711. [PMID: 31365942 DOI: 10.1055/s-0039-1693463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe. METHODS Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization. RESULTS Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65-1.01, p = 0.065). CONCLUSION DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.
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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, United States
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ioannis Mastoris
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Mitchell W Krucoff
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, United States
| | - Giora Weisz
- Montefiore Medical Center, New York, New York, United States
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Michela Faggioni
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | | | | | | | - David J Cohen
- St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, United States
| | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, United States
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Baber U, Li SX, Pinnelas R, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv 2019; 11:e006144. [PMID: 29870385 DOI: 10.1161/circinterventions.117.006144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 10/27/2017] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
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Affiliation(s)
- Usman Baber
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Shawn X Li
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Rebecca Pinnelas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Stuart J Pocock
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Mitchell W Krucoff
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Cono Ariti
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - C Michael Gibson
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Philippe Gabriel Steg
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Giora Weisz
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Bernhard Witzenbichler
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Timothy D Henry
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Annapoorna S Kini
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Thomas Stuckey
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Cohen
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Ioannis Iakovou
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - George Dangas
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Melissa B Aquino
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Samantha Sartori
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Alaide Chieffo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - David J Moliterno
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Antonio Colombo
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.)
| | - Roxana Mehran
- From the Mount Sinai School of Medicine, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Dartmouth Geisel School of Medicine, Hanover, NH (S.X.L.); New York University Medical Center (R.P.); London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Duke University School of Medicine, Durham, NC (M.W.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (C.M.G.); Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France (P.G.S.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Onassis Cardiac Surgery Center, Athens, Greece (I.I.); San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A. Colombo); and University of Kentucky, Lexington (D.J.M.).
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7
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Shlofmitz E, Maehara A, Witzenbichler B, Metzger D, Rinaldi M, Mazzaferri E, Duffy P, Weisz G, Neumann FJ, Henry T, Cox D, Stuckey T, Brodie B, Liu Y, Kirtane A, Mintz G, Stone G. IMPACT OF SMALL DEVICE USE IN THE PROXIMAL LAD VERSUS OTHER CORONARY SEGMENTS ON LONG-TERM CLINICAL OUTCOMES: AN ADAPT-DES SUB-ANALYSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31603-6] [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: 10/17/2022]
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8
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Schoos M, Chandrasekhar J, Baber U, Bhasin A, Sartori S, Aquino M, Vogel B, Farhan S, Sorrentino S, Kini A, Kruckoff M, Moliterno D, Henry TD, Weisz G, Gibson CM, Iakovou I, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen D, Stuckey T, Ariti C, Dangas G, Pocock S, Mehran R. Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry). Am J Cardiol 2017; 120:904-910. [PMID: 28778417 DOI: 10.1016/j.amjcard.2017.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/23/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022]
Abstract
Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for <14 days. Of the study cohort, 490 patients (9.8%) experienced 594 DAPT interruptions over 2 years following PCI. Only 1 antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT interruptions occurred for minor surgery (68.4% vs 31.6%) and a similar cessation pattern of single versus dual antiplatelet cessation was observed regardless of minor or major surgery. Subsequent to DAPT interruption, 12 patients (2.4%) experienced 1 thrombotic event each, of which 5 (1.0%) occurred during the interruption period. All events occurred in patients who either stopped both agents (8 of 12) or clopidogrel-only (4 of 12), with no events occurring due to aspirin cessation alone. In conclusion, in the Patterns of Non-adherence to Anti-platelet Regiments in Stented Patients registry, 1 in 10 patients were recommended DAPT interruption for surgery within 2 years of PCI. Interruption was more common for a single agent rather than both antiplatelet agents regardless of severity of surgery, and was frequently recommended by noncardiologists. Only 1% of patients with DAPT interruption experienced a subsequent thrombotic event during the interruption period, which mainly occurred in patients stopping both antiplatelet agents.
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Affiliation(s)
- Mikkel Schoos
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Zealand University Hospital, Denmark
| | - Jaya Chandrasekhar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Usman Baber
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aarti Bhasin
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Wyckoff Heights Medical Center, New York, New York
| | - Samantha Sartori
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Aquino
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Birgit Vogel
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sabato Sorrentino
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mitchell Kruckoff
- Department of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - David Moliterno
- Department of Cardiology, University of Kentucky, Lexington, Kentucky
| | - Timothy D Henry
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Giora Weisz
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - C Michael Gibson
- Department of Cardiology, Harvard Medical School, Cambridge, Massachusetts
| | - Ioannis Iakovou
- Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Antonio Colombo
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - P Gabriel Steg
- Department of Cardiology, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Alaide Chieffo
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - David Cohen
- Department of Cardiology, St Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina
| | - Cono Ariti
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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9
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Shah B, Baber U, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. White Blood Cell Count and Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in the Contemporary Era. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.004981. [DOI: 10.1161/circinterventions.117.004981] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Received: 01/11/2017] [Accepted: 07/10/2017] [Indexed: 12/28/2022]
Abstract
Background—
Elevated white blood cell (WBC) count is associated with increased major adverse cardiovascular events (MACE) in the setting of acute coronary syndrome. The aim of this study was to evaluate whether similar associations persist in an all-comers population of patients undergoing percutaneous coronary intervention in the contemporary era.
Methods and Results—
In the multicenter, prospective, observational PARIS study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry), 4222 patients who underwent percutaneous coronary intervention in the United States and Europe between July 1, 2009, and December 2, 2010, were evaluated. The associations between baseline WBC and MACE (composite of cardiac death, stent thrombosis, spontaneous myocardial infarction, or target lesion revascularization) at 24-month follow-up were analyzed using multivariable Cox regression. Patients with higher WBC were more often younger, smokers, and with less comorbid risk factors compared with those with lower WBC. After adjustment for baseline and procedural characteristics, WBC remained independently associated with MACE (hazard ratio [HR] per 10
3
cells/μL increase, 1.05 [95% confidence intervals (CI), 1.02–1.09];
P
=0.001), cardiac death (HR, 1.10 [95% CI, 1.05–1.17];
P
<0.001), and clinically indicated target revascularization (HR, 1.04 [95% CI, 1.00–1.09];
P
=0.03) but not stent thrombosis (HR, 1.07 [95% CI, 0.99–1.16];
P
=0.10) or spontaneous myocardial infarction (HR, 1.03 [95% CI, 0.97–1.09];
P
=0.29). The association between WBC and MACE was consistent in acute coronary syndrome and non–acute coronary syndrome presentations (interaction
P
=0.15).
Conclusions—
Increased WBC is an independent predictor of MACE after percutaneous coronary intervention in a contemporary all-comers cohort. Further studies to delineate the underlying pathophysiologic role of elevated WBC across a spectrum of coronary artery disease presentations are warranted.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00998127.
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Affiliation(s)
- Binita Shah
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Usman Baber
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Stuart J. Pocock
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Mitchell W. Krucoff
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Cono Ariti
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - C. Michael Gibson
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Philippe Gabriel Steg
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Giora Weisz
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Bernhard Witzenbichler
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Timothy D. Henry
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Annapoorna S. Kini
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Thomas Stuckey
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - David J. Cohen
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Ioannis Iakovou
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - George Dangas
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Melissa B. Aquino
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Samantha Sartori
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Alaide Chieffo
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - David J. Moliterno
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Antonio Colombo
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
| | - Roxana Mehran
- From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine,
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Chandrasekhar J, Baber U, Sartori S, Aquino M, Tomey M, Kruckoff M, Moliterno D, Henry TD, Weisz G, Gibson CM, Iakovou I, Kini A, Faggioni M, Vogel B, Farhan S, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen D, Stuckey T, Ariti C, Pocock S, Dangas G, Mehran R. Patterns and associations between DAPT cessation and 2-year clinical outcomes in left main/proximal LAD versus other PCI: Results from the Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients (PARIS) registry. Int J Cardiol 2017; 243:132-139. [DOI: 10.1016/j.ijcard.2017.05.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/22/2017] [Accepted: 05/10/2017] [Indexed: 11/28/2022]
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11
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Shah B, Baber U, Krucoff M, Aquino M, Henry T, Gibson CM, Moliterno D, Steg PG, Stuckey T, Pocock S, Dangas G, Ariti C, Witzenbichler B, Cohen D, Iakovou I, Sartori S, Chieffo A, Kini A, Colombo A, Weisz G, Mehran R. WHITE BLOOD CELL COUNT AND MAJOR ADVERSE CARDIOVASCULAR EVENTS AFTER PERCUTANEOUS CORONARY INTERVENTION IN THE CONTEMPORARY ERA: INSIGHTS FROM THE PARIS STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Goswami R, Stuckey T, Meine F, Singh N, Depta J, Gupta S, Ramchandani S, Crawford RS, Burton T, Sanders WE. CORONARY ARTERY DISEASE LEARNING AND ALGORITHM DEVELOPMENT STUDY: EARLY ANALYSIS OF EJECTION FRACTION EVALUATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34342-5] [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: 10/20/2022]
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13
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Redfors B, Genereux P, Kirtane A, Witzenbichler B, Rinaldi M, Neumann F, Metzger D, Henry T, Cox D, Duffy PL, Mazzaferri E, Gurbel P, Brodie B, Stuckey T, McAndrew T, Diamond JE, Huang X, Mehran R, Stone G. PLATELET REACTIVITY AND OUTCOMES AFTER PCI OF SAPHENOUS VEIN GRAFTS VERSUS NATIVE CORONARY ARTERIES: THE ADAPT-DES STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34479-0] [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: 11/24/2022]
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14
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Chung C, Kirtane A, Litherland C, Witzenbichler B, Weisz G, Stuckey T, Brodie B, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy PL, Mazzaferri E, Mehran R, Stone G. TCT-8 Impact of Aspirin Resistance on Outcomes after Coronary Events. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.015] [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: 10/20/2022]
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15
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Redfors B, Ben-Yehuda O, Lin SH, Furer A, Kirtane A, Witzenbichler B, Weisz G, Stuckey T, Maehara A, Généreux P, Giustino G, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy PL, Mazzaferri E, Ayele G, Mehran R, Mintz G, Stone G. TCT-352 Proportion of Ischemic Risk After PCI Mediated by High Platelet Reactivity on Clopidogrel: Analysis From the ADAPT-DES Study. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.483] [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: 10/20/2022]
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Chandrasekhar J, Baber U, Sartori S, Pinnelas R, Henry T, Moliterno D, Cohen D, Weisz G, Kini A, Bruckel J, Pocock S, Steg PG, Witzenbichler B, Colombo A, Chieffo A, Iakovou I, Dangas G, Gibson CM, Stuckey T, Mehran R. TCT-211 Incidence and Impact of Dual Antiplatelet Therapy Cessation on Clinical Outcomes in Patients with Renal Dysfunction: Insights from the PARIS Registry. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.262] [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: 10/20/2022]
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Chandrasekhar J, Baber U, Sartori S, Aquino M, Stuckey T, Henry T, Moliterno D, Cohen D, Steg PG, Iakovou I, Bruckel J, Pocock S, Kini A, Colombo A, Chieffo A, Witzenbichler B, Weisz G, Dangas G, Gibson CM, Mehran R. TCT-205 Incidence and clinical outcomes associated with DAPT discontinuation in complex PCI patients: From the PARIS registry. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parikh P, Kirtane A, Weisz G, Stuckey T, Ozan MO, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy PL, Brodie B, Mazzaferri E, Mehran R, Stone G. TCT-353 Underweight Status, Platelet Reactivity, and 2-Year Clinical Outcomes in Patients Undergoing PCI With DES: An ADAPT-DES Study Analysis. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.484] [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: 10/20/2022]
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Redfors B, Généreux P, Maehara A, Kirtane A, Dordi R, Witzenbichler B, Weisz G, Stuckey T, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy PL, Mazzaferri E, Litherland C, Mehran R, Mintz G, Stone G. TCT-237 Outcomes After Successful PCI of Severely Calcified Lesions Using Rotational Atherectomy, Cutting Balloon, or Balloon Angioplasty only Before Second-Generation Drug-Eluting Stent Implantation. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.248] [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: 10/20/2022]
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Chandrasekhar J, Bansilal S, Baber U, Sartori S, Aquino M, Farhan S, Vogel B, Faggioni M, Giustino G, Ariti C, Colombo A, Chieffo A, Kini A, Saporito R, Michael Gibson C, Witzenbichler B, Cohen D, Moliterno D, Stuckey T, Henry T, Pocock S, Dangas G, Gabriel Steg P, Mehran R. Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry. Catheter Cardiovasc Interv 2016; 89:E217-E225. [DOI: 10.1002/ccd.26716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Usman Baber
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Melissa Aquino
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | | | | | | | | | | | | | - David Cohen
- St Luke's Mid America Heart Institute, University of Missouri-Kansas City; Kansas City Missouri
| | | | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation; Greensboro North Carolina
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | - George Dangas
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai; New York New York
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Kereiakes DJ, Meredith I, Windecker S, Kabour A, Bouchard A, Kini A, Janssens L, Foster M, Stoler R, Stuckey T, Batchelor W, Christen T, Allocco D, Dawkins K. LATE CLINICAL OUTCOMES AFTER BIORESORBABLE OR PERMANENT POLYMER EVEROLIMUS-ELUTING STENTS: 2-YEAR RESULTS FROM THE EVOLVE II RANDOMIZED TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Genereux P, Gravel GM, Witzenbichler B, Weisz G, Stuckey T, Rinaldi M, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Ramteke GB, Litherland C, Kirtane AJ, Mehran R, Stone GW. TCT-597 Two-Year Ischemic and Bleeding Outcomes After Coronary Intervention of Calcified vs. Non-Calcified Lesions Treated With Drug-eluting Stents: The ADAPT-DES Study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.1067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shan P, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Kirtane A, Stone G, Maehara A. DOES CALCIUM BURDEN IMPACT ON CULPRIT LESION MORPHOLOGY AND CLINICAL. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aoi S, Yu J, Sartori S, Baber U, Ariti C, Henry T, Cohen D, Moliterno D, Pocock S, Gibson CM, Stuckey T, Berger P, Iakovou I, Waksman R, Hermiller J, Mehran R. IMPACT OF AGE ON THE MODES OF DUAL ANTIPLATELET THERAPY CESSATION: ANALYSIS FROM THE PARIS (PATTERNS OF NON-ADHERENCE TO ANTI-PLATELET REGIMENS IN STENTED PATIENTS) REGISTRY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61813-7] [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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Yu J, Mehran R, Baber U, Ooi SY, Witzenbichler B, Weisz G, Rinaldi M, Neumann FJ, Metzger D, Henry T, Cox D, Duffy P, Mazzaferri E, Brodie B, Stuckey T, Maehara A, Xu K, Kirtane A, Stone G. DIFFERENTIAL IMPACT OF HIGH PLATELET REACTIVITY ON CLOPIDOGREL IN WOMEN AND MEN FOLLOWING PERCUTANEOUS CORONARY INTERVENTION (PCI) WITH DES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61690-4] [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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Rubin GA, Kirtane A, Weisz G, Baber U, Xu K, Parise H, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Mehran R, Stone G. IMPACT OF HEMODIALYSIS AND HIGH PLATELET REACTIVITY ON OUTCOMES FOLLOWING PERCUTANEOUS CORONARY INTERVENTION WITH DRUG-ELUTING STENTS: AN ADAPT-DES SUBSTUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Qiu F, Mintz G, Witzenbichler B, Metzger D, Rinaldi M, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Kirtane A, Stone G, Maehara A. CLINICAL IMPACT OF TISSUE PROTRUSION AFTER STENT IMPLANTATION: AN ADAPT-DES IVUS SUBSTUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baber U, Schoos M, Sartori S, Steg P, Ariti C, Weisz G, Witzenbichler B, Henry T, Kini A, Stuckey T, Cohen DJ, Berger PB, Dangas G, Waksman R, Antoniucci D, Krucoff M, Hermiller J, Shawl F, Gibson CM, Chieffo A, Alu M, Moliterno D, Colombo A, Pocock S, Mehran R. TEMPORAL ASSOCIATIONS BETWEEN TIME AFTER PERCUTANEOUS CORONARY INTERVENTION, DUAL ANTIPLATELET THERAPY CESSATION AND STENT THROMBOSIS IN THE CONTEMPORARY PCI ERA: INSIGHTS FROM THE PARIS REGISTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61728-9] [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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Kobayashi N, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Kirtane A, Stone G, Maehara A. INCIDENCE, FEATURES, AND OUTCOMES OF EDGE DISSECTION AFTER DRUG-ELUTING STENT IMPLANTATION: AN ADAPT-DES IVUS SUB-STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61696-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: 10/25/2022]
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Theodoropoulos K, Kini A, Witzenbichler B, Weisz G, Hermiller J, Shawl F, Stuckey T, Chieffo A, Berger P, Cohen D, Waksman R, Aquino M, sartori S, Baber U, Dangas G, Mehran R. IMPACT OF BODY MASS INDEX ON MAJOR BLEEDING AFTER PCI: 2-YEAR RESULTS FROM THE MULTICENTER PROSPECTIVE PARIS REGISTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61880-5] [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: 10/25/2022]
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Parikh P, Kirtane A, Weisz G, Stuckey T, Xu K, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. TWO-YEAR CLINICAL OUTCOMES OF SECOND GENERATION VERSUS FIRST GENERATION CORONARY DRUG-ELUTING STENTS: AN ANALYSIS FROM ADAPT-DES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61899-4] [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: 10/25/2022]
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Gupta R, Kirtane A, Xu K, Witzenbichler B, Rinaldi M, Metzger C, Weisz G, Stuckey T, Brodie B, Mehran R, Stone G. PLATELET REACTIVITY AND CLINICAL OUTCOMES AFTER CORONARY ARTERY IMPLANTATION OF DRUG-ELUTING STENTS IN SUBJECTS WITH PERIPHERAL ARTERIAL DISEASE: ANALYSIS FROM THE ADAPT-DES STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61865-9] [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: 12/01/2022]
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Mehran R, Baber U, Steg PG, Ariti C, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Berger PB, Iakovou I, Dangas G, Waksman R, Antoniucci D, Sartori S, Krucoff MW, Hermiller JB, Shawl F, Gibson CM, Chieffo A, Alu M, Moliterno DJ, Colombo A, Pocock S. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 2013; 382:1714-22. [PMID: 24004642 DOI: 10.1016/s0140-6736(13)61720-1] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) cessation increases the risk of adverse events after percutaneous coronary intervention (PCI). Whether risk changes over time, depends on the underlying reason for DAPT cessation, or both is unknown. We assessed associations between different modes of DAPT cessation and cardiovascular risk after PCI. METHODS The PARIS (patterns of non-adherence to anti-platelet regimens in stented patients) registry is a prospective observational study of patients undergoing PCI with stent implantation in 15 clinical sites in the USA and Europe between July 1, 2009, and Dec 2, 2010. Adult patients (aged 18 years or older) undergoing successful stent implantation in one or more native coronary artery and discharged on DAPT were eligible for enrolment. Patients were followed up at months 1, 6, 12, and 24 after implantation. Prespecified categories for DAPT cessation included physician-recommended discontinuation, brief interruption (for surgery), or disruption (non-compliance or because of bleeding). All adverse events and episodes of DAPT cessation were independently adjudicated. Using Cox models with time-varying covariates, we examined the effect of DAPT cessation on major adverse events (MACE [composite of cardiac death, definite or probable stent thrombosis, myocardial infarction, or target-lesion revascularisation]). Incidence rates for DAPT cessation and adverse events were calculated as Kaplan-Meier estimates of time to the first event. This study is registered with ClinicalTrials.gov, number NCT00998127. FINDINGS We enrolled 5031 patients undergoing PCI, including 5018 in the final study population. Over 2 years, the overall incidence of any DAPT cessation was 57·3%. Rate of any discontinuation was 40·8%, of interruption was 10·5%, and of disruption was 14·4%. The corresponding overall 2 year MACE rate was 11·5%, most of which (74%) occurred while patients were taking DAPT. Compared with those on DAPT, the adjusted hazard ratio (HR) for MACE due to interruption was 1·41 (95% CI 0·94-2·12; p=0·10) and to disruption was 1·50 (1·14-1.97; p=0·004). Within 7 days, 8-30 days, and more than 30 days after disruption, adjusted HRs were 7·04 (3·31-14·95), 2·17 (0·97-4·88), and 1·3 (0·97-1·76), respectively. By contrast with patients who remained on DAPT, those who discontinued had lower MACE risk (0·63 [0·46-0·86]). Results were similar after excluding patients receiving bare metal stents and using an alternative MACE definition that did not include target lesion revascularisation. INTERPRETATION In a real-world setting, for patients undergoing PCI and discharged on DAPT, cardiac events after DAPT cessation depend on the clinical circumstance and reason for cessation and attenuates over time. While most events after PCI occur in patients on DAPT, early risk for events due to disruption is substantial irrespective of stent type. FUNDING Bristol-Myers Squibb and Sanofi-Aventis.
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Affiliation(s)
- Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi M, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Stone G, Maehara A. TCT-597 Predictors of Stent Expansion After Drug-eluting Stents: An ADAPT-DES IVUS substudy. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1344] [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: 11/24/2022]
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Baber U, Mehran R, Kirtane AJ, Gurbel PA, Christodoulidis G, Witzenbichler B, Weisz G, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Xu K, Parise H, Brodie BR, Stuckey T, Stone G. TCT-6 Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results from the ADAPT-DES Registry. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.733] [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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Weisz G, Kirtane AJ, Xu K, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Parise H, Mehran R, Stone G. TCT-155 The Interaction Between Clopidogrel and Calcium Channel Blockers on Platelet Reactivity and Long-Term Events after PCI. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.888] [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: 11/24/2022]
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Kang SJ, Mintz GS, Witzenbichler B, Metzger DC, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Maehara A. TCT-664 Impact of Obesity on Coronary Atherosclerosis Assessed by Grayscale and Virtual histology Intravascular Ultrasound. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Trenk D, Brodie BR, Büttner HJ, Cox D, Duffy PL, Henry TD, Kirtane AJ, Mazzaferri EL, Mehran R, Metzger DC, Stone GW, Stuckey T, Weisz G, Witzenbichler B, Xu K, Neumann FJ. TCT-156 Impact of Clopidogrel Hyporesponsiveness on Clinical Outcomes in Patients Receiving Drug-eluting Stents for Stable Coronary Disease in the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.889] [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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Stuckey T, Kirtane AJ, Brodie BR, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Chavez IJ, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Mehran R, Guerchicoff A, Parise H, Stone G. TCT-5 Relationship Between High Platelet Reactivity on Clopidogrel and Outcomes After DES Implantation: Two-Year Results From the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.732] [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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Dong L, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi M, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Stone GW, Maehara A. TCT-671 Relationship Between Plaque Morphologies And Clinical Presentation In The ADAPT-DES IVUS Substudy. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kirtane AJ, Stuckey T, Xu K, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Cristea E, Parise H, Mehran R, Stone G. TCT-152 Is There a Therapeutic Window For Platelet Responsiveness Among PCI Patients? Analysis from the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maehara A, Weisz G, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Stuckey T, Mazzaferri EL, Xu K, Mehran R, Parise H, Mintz GS, Stone GW. TCT-68 Does IVUS Reduce Stent Thrombosis with DES? Two-year results from the prospective, multicenter ADAPT-DES study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garg A, Brodie BR, Stuckey T, Xu K, Kirtane AJ, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Mehran R, Stone G. TCT-18 Clinical and Procedural Predictors and Consequences of Stent Thrombosis Following Drug-eluting Stents for Acute Coronary Syndromes: Results From the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Weisz G, Kirtane AJ, Xu K, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Parise H, Mehran R, Stone G. TCT-157 The Effect of Smoking Status on Platelet Reactivity and Long-Term Events after PCI. Does a Clopidogrel-related "Smoker's paradox" Exist? J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tobbia P, Brodie BR, Witzenbichler B, Metzger C, Guagliumi G, Yu J, Kellett MA, Stuckey T, Fahy M, Mehran R, Stone GW. Adverse event rates following primary PCI for STEMI at US and non-US hospitals: three-year analysis from the HORIZONS-AMI trial. EUROINTERVENTION 2013; 8:1134-42. [PMID: 23425539 DOI: 10.4244/eijv8i10a176] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To examine outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) at US sites versus sites outside the US (OUS). METHODS AND RESULTS In the HORIZONS-AMI trial 3,602 STEMI patients in 11 countries were randomised to primary PCI with bivalirudin versus heparin + glycoprotein IIb/IIIa inhibitors. US patients (n=814) had more diabetes, prior infarction, prior bypass surgery, and renal insufficiency. OUS patients (n=2,788) had longer door-to-balloon times, more radial access, fewer bypass surgeries, and were discharged more often on beta-blockers and statins. At three years US patients had higher mortality (9.7% vs. 6.0%, p=0.0003), reinfarction (10.2% vs. 6.4%, p=0.001), major adverse cardiac events (MACE; 28.2% vs. 20.1%, p<0.0001), major bleeding (16.9% vs. 6.4%, p<0.0001) and net adverse clinical events (NACE; 36.6% vs. 23.8%, p<0.0001), which persisted after adjusting for baseline risk. CONCLUSIONS In the HORIZONS-AMI trial, STEMI patients undergoing primary PCI at US versus OUS sites had higher rates of adverse events, which persisted after adjusting for baseline risk. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care and treatments.
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Affiliation(s)
- Patrick Tobbia
- LeBauer Cardiovascular Research Foundation and Moses Cone Hospital, Greensboro, NC 27408, USA
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Tobbia P, Brodie BR, Stuckey T, McLaurin BT, Cox DA, Fahy M, Xu K, Mehran R, Stone GW. Are adverse events following an invasive strategy in patients with non-ST-segment elevation acute coronary syndromes more frequent at US sites versus non-US sites? Analysis from the ACUITY trial. Catheter Cardiovasc Interv 2013; 82:E365-74. [PMID: 22887494 DOI: 10.1002/ccd.24587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/30/2012] [Revised: 07/27/2012] [Accepted: 07/28/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare outcomes between US and non-US (OUS) sites in patients with non ST-elevation acute coronary syndromes (NSTEACS) and to evaluate potential reasons for differences in outcomes. BACKGROUND There are little data comparing outcomes at US versus OUS sites in patients with NSTEACS managed with an invasive strategy. METHODS The ACUITY trial randomized 13,819 patients with NSTEACS in 17 countries to an invasive approach with one of three strategies: (1) heparin plus glycoprotein platelet inhibitors (GPI), (2) bivalirudin plus GPI, or (3) bivalirudin alone. RESULTS US patients were more often female, were younger, heavier, and had more diabetes, prior myocardial infarction (MI), and prior bypass surgery. US patients were less often treated with percutaneous coronary intervention but had more frequent drug-eluting stent use. US patients had lower mortality and higher MI rates at 30 days and 1 year and higher composite ischemic outcome at 30 days. After adjusting for differences in baseline variables, US patients had higher rates of MI and composite ischemic outcome at 30 days and higher rates of MI at 1 year {HR [95% confidence interval (CI)] = 1.36 [1.18-1.56], P < 0.0001} with no differences in mortality. There were no differences in treatment effects comparing bivalirudin with the other strategies between US and OUS sites. CONCLUSIONS US versus OUS patients with NSTEACS had higher adjusted rates of MI and ischemia. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care which may impact outcomes.
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Affiliation(s)
- Patrick Tobbia
- LeBauer Cardiovascular Research Foundation and Cone Health, Greensboro, North Carolina
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Inaba S, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Mazzaferri E, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Mehran R, Stone G, Maehara A. IMPACT OF POSITIVE AND NEGATIVE CORONARY REMODELING ON CULPRIT LESION MORPHOMETRY: THE ADAPT–DES IVUS SUBSTUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61788-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: 10/27/2022]
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Stone GW, Teirstein P, Meredith I, Stoler R, Rabinowitz A, Pompili V, Kabour A, Stuckey T, Curzen N, Saito S, Erglis A, Allocco DJ, Dawkins KD. THREE–YEAR RESULTS OF THE PLATINUM RANDOMIZED TRIAL COMPARING PLATINUM CHROMIUM PROMUS ELEMENT AND COBALT CHROMIUM PROMUS/XIENCE v EVEROLIMUS–ELUTING STENTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61732-5] [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: 11/17/2022]
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Inaba S, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Mazzaferri E, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Mehran R, Stone G, Maehara A. MYOCARDIAL BRIDGING DOES NOT AFFECT ATHEROSCLEROSIS IN ADJACENT CORONARY ARTERY SEGMENTS: AN ADAPT–DES IVUS SUB–STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61779-9] [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: 11/28/2022]
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Rinaldi MJ, Kirtane A, Xu K, Witzenbichler B, Weisz G, Neumann F, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Stuckey T, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. IMPACT OF POINT–OF–CARE PLATELET FUNCTION TESTING AMONG PATIENTS WITH AND WITHOUT ACUTE CORONARY SYNDROMES UNDERGOING PCI WITH DRUG–ELUTING STENTS: AN ADAPT–DES SUBSTUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61857-4] [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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