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Bruno F, de Filippo O, Sardone A, Capranzano P, Conrotto F, Sheiban I, Giacobbe F, Laudani C, Burzotta F, Saia F, Escaned J, Raposeiras Roubin S, Mancone M, Templin C, Candreva A, Trabattoni D, Wanha W, Stefanini G, Chieffo A, Cortese B, Casella G, Wojakowski W, Colombo F, De Ferrari GM, Boccuzzi G, D'Ascenzo F, Iannaccone M. Long-term impact of intravascular ultrasound-guidance for percutaneous coronary intervention on unprotected left main. The IMPACTUS-LM, an observational, multicentric study. Int J Cardiol 2024; 401:131861. [PMID: 38365014 DOI: 10.1016/j.ijcard.2024.131861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The potential benefit on long term outcomes of Percutaneous Coronary Intervention (PCI) on Unprotected Left Main (ULM) driven by IntraVascular UltraSound (IVUS) remains to be defined. METHODS IMPACTUS LM-PCI is an observational, multicenter study that enrolled consecutive patients with ULM disease undergoing coronary angioplasty in 13 European high-volume centers from January 2002 to December 2015. Major Adverse Cardiovascular Events (MACEs) a composite of cardiovascular (CV) death, target vessel revascularization (TVR) and myocardial infarction (MI) were the primary endpoints, while its single components along with all cause death the secondary ones. RESULTS 627 patients with ULM disease were enrolled, 213 patients (34%) underwent IVUS-guided PCI while 414 (66%) angioguided PCI. Patients in the two cohorts had similar prevalence of risk factors except for active smoking and clinical presentation. During a median follow-up of 7.5 years, 47 (22%) patients in the IVUS group and 211 (51%) in the angio-guided group underwent the primary endpoint (HR 0.42; 95% CI [0.31-0.58] p < 0.001). After multivariate adjustment, IVUS was significantly associated with a reduced incidence of the primary endpoint (adj HR 0.39; 95% CI [0.23-0.64], p < 0.001), mainly driven by a reduction of TVR (ad HR 0.30, 95% CI [0.15-0.62], p = 0.001) and of all-cause death (adj HR 0.47, 95% CI [0.28-0.82], p = 0.008). IVUS use, age, diabetes, side branch stenosis, DES and creatinine at admission were independent predictors of MACE. CONCLUSIONS In patients undergoing ULM PCI, the use of IVUS was associated with a reduced risk at long-term follow-up of MACE, all-cause death and subsequent revascularization.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy..
| | - Ovidio de Filippo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Sardone
- San Giovanni Bosco Hospital, ASL Città Torino, Turin, Italy
| | - Piera Capranzano
- Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy
| | - Federico Conrotto
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Imad Sheiban
- Division of Cardiology, Peschiera del Garda Hospital, Verona, Italy
| | - Federico Giacobbe
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Claudio Laudani
- Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Universidad Complutense de Madrid, Calle del Prof Martín Lagos, 28040 Madrid, Spain
| | | | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | | | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
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Gruz-Kwapisz M, Gasior T, Hajder A, Wanha W, Ciosek J, Ochala A, Parma R, Gocol R, Wojakowski W, Hudziak D. The role of external iliac artery diameter indexed to BSA score in predicting vascular access complications after transfemoral transcatheter aortic valve implantation. Postepy Kardiol Interwencyjnej 2024; 20:76-83. [PMID: 38616934 PMCID: PMC11008513 DOI: 10.5114/aic.2024.136407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Aortic stenosis is the most common primary valve disease and requires invasive treatment. Transcatheter aortic valve implantation (TAVI) from a transfemoral access is a routine intervention worldwide. Aim To investigate the correlation between external iliac artery diameter (EIAD) indexed to body surface area (BSA) (EIAD-BSA) and access site complications in patients undergoing TAVI via transfemoral access (TF) (TF-TAVI). Material and methods Patients underwent TF-TAVI in 2017-2019 at the Upper-Silesian Medical Center in Katowice. Based on the preoperative multi-slice computed tomography (MSCT), pre-specified measurements of the ilio-femoral vessels were performed. The results were indexed to BSA and body mass index (BMI). Complications after TAVI were defined by Valve Academic Research Consortium 3 (VARC-3). The primary outcome regarding the adverse events after TAVI was the composite of access site complications requiring surgical intervention or blood transfusion. Results The registry included 193 unselected patients with severe symptomatic aortic stenosis. Vascular and access-related complications including bleeding occurred in 17.1% of patients. Major TAVI access site complications (VARC-3) were reported in 5.7% of patients, while minor complications (VARC-3) occurred in 2.6%. EIAD-BSA demonstrated a positive correlation with the access site complications primary endpoint. Patients with greater EIAD-BSA had a numerically higher number of access site adverse events requiring surgical intervention or blood transfusion: n = 12 (5%) vs. n = 4 (4%), p = 0.011. Conclusions External iliac artery diameter indexed to BSA could be an underestimated indicator of unfavorable outcomes after TF-TAVI, predicting periprocedural access site complications.
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Affiliation(s)
- Monika Gruz-Kwapisz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Gasior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Collegium Medicum – Faculty of Medicine, WSB University, Dabrowa Gornicza, Poland
| | - Adrianna Hajder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Joanna Ciosek
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Ochala
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
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Bruno F, Kang J, Elia E, Han JK, De Filippo O, Yang HM, Gallone G, Park KW, De Luca L, Kang HJ, Quadri G, Gwon HC, Chun WJ, Giannino G, Hur SH, Han SH, Truffa A, Bin Song Y, Cortese B, Choi KH, Chieffo A, Hong SJ, Di Pietro G, Doh JH, Wanha W, Nam CW, Kim HS, Mattesini A, de De Ferrari GM, Koo BK, D'Ascenzo F. Impact of diabetes on long-term outcomes of bifurcation percutaneous coronary intervention. An analysis from the BIFURCAT registry. Catheter Cardiovasc Interv 2023; 102:620-630. [PMID: 37668085 DOI: 10.1002/ccd.30802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/29/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND It is still unclear the impact of diabetes mellitus (DM) in complex coronary lesions treated with percutaneous coronary intervention (PCI) which themselves are at increased incidence of adverse events. METHODS BIFURCAT registry encompassed patients treated with PCI for coronary bifurcation lesion from the COBIS III and the RAIN registry. The primary endpoint was the occurrence of major cardiovascular adverse event (MACE), a composite and mutual exclusive of all-cause death or myocardial infarction (MI) or target-lesion revascularization (TLR). A total of 5537 patients were included in the analysis and 1834 (33%) suffered from DM. RESULTS After a median follow-up of 21 months, diabetic patients had a higher incidence of MACE (17% vs. 9%, p < 0.001), all-cause mortality (9% vs. 4%, p < 0.001), TLR (5% vs. 3%, p = 0.001), MI (4% vs. 2%, p < 0.001), and stent thrombosis (ST) (2% vs. 1%, p = 0.007). After multivariate analysis, diabetes remained significantly associated with MACE (hazard ratio [HR]: 1.37; confidence interval [CI]: 1.13-1.65; p = 0.001), all-cause death (HR: 1.65; 95% CI: 1.24-2.19, p = 0.001), TLR (HR: 1.45; CI: 1.03-2.04; p = 0.031) and ST (HR: 1.73, CI: 1.04-2.88; p = 0.036), but not with MI (HR: 1.34; CI: 0.93-1.92; p = 0.11). Among diabetics, chronic kidney disease (HR: 2.99; CI: 2.21-4.04), baseline left ventricular ejection fraction (HR: 0.98; CI: 0.97-0.99), femoral access (HR: 1.62; CI: 1.23-2.15), left main coronary artery (HR: 1.44; CI: 1.06-1.94), main branch diameter (HR: 0.79; CI: 0.66-0.94) and final kissing balloon (HR: 0.70; CI: 0.52-0.93) were independent predictors of MACE at follow-up. CONCLUSIONS Patients with DM treated with PCI for coronary bifurcations have a worse prognosis due to higher incidence of MACE, all-cause mortality, TLR and ST compared to the non-diabetics.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Edoardo Elia
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Kyung-Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Hyeon-Cheol Gwon
- Department of Cardiology, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, South Korea
| | - Giuseppe Giannino
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, South Korea
| | | | - Young Bin Song
- Department of Cardiology, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea
| | - Bernardo Cortese
- Division of cardiology, Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Ki Hong Choi
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, South Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, South Korea
| | - Gianluca Di Pietro
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Wojciech Wanha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
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4
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Bruno F, Marengo G, De Filippo O, Wanha W, Leonardi S, Raposeiras Roubin S, Fabris E, Popovic M, Giannino G, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez‐Gil IJ, Melis D, Ugo F, Bianco M, Barbieri L, Marchini F, Desperak P, Montalto C, Melendo‐Viu M, Elia E, Mancone M, Buono A, Ferrandez‐Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Sardella G, Gasior M, Mazurek M, Gallone G, Pagliaro B, Lopiano C, Campo G, Wojakowski W, Abu‐Assi E, Sinagra G, De Ferrari GM, D'Ascenzo F. Impact of Complete Revascularization on Development of Heart Failure in Patients With Acute Coronary Syndrome and Multivessel Disease: A Subanalysis of the CORALYS Registry. J Am Heart Assoc 2023; 12:e028475. [PMID: 37489724 PMCID: PMC10492970 DOI: 10.1161/jaha.122.028475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 07/26/2023]
Abstract
Background The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy-three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49-0.90]) along with all-cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56-0.97] and HR, 0.56 [95% CI, 0.38-0.84], respectively). The results were consistent in the propensity-score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39-0.89] for ST-segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50-0.99] for non-ST-elevation acute coronary syndrome) and in patients with left ventricular ejection fraction >40% (HR, 0.52 [95% CI, 0.37-0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37-1.10], P for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST-segment elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895176.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Giorgio Marengo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Ovidio De Filippo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Maja Popovic
- Department of Medical SciencesUniversity of TurinItaly
| | - Giuseppe Giannino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Zenon Huczek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | | | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed InterventisticaIstituto Clinico Sant’AmbrogioMilanItaly
| | - Bernardo Cortese
- Cardiovascular Research TeamSan Carlo ClinicMilanItaly
- Fondazione Ricerca e Innovazione CardiovascolareMilanItaly
| | - Andrea Borin
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Daniele Melis
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio Ugo
- Department of CardiologySant’Andrea HospitalVercelliItaly
| | - Matteo Bianco
- Division of CardiologySan Luigi Gonzaga University Hospital, OrbassanoTurinItaly
| | - Lucia Barbieri
- Division of CardiologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- University of MilanMilanItaly
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Piotr Desperak
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Claudio Montalto
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Edoardo Elia
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente‐Fondazione Don Carlo Gnocchi ONLUSMilanItaly
| | | | | | - Gennaro Sardella
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Mariusz Gasior
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Maciej Mazurek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | - Guglielmo Gallone
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Beniamino Pagliaro
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Clara Lopiano
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Gaetano Maria De Ferrari
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio D'Ascenzo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
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5
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Kim JH, Franchin L, Hong SJ, Cha JJ, Lim S, Joo HJ, Park JH, Yu CW, Lim DS, Filippo OD, Gwon HC, Piroli F, Kim HS, Wanha W, Choi KH, Song YB, Patti G, Nam CW, Bruno F, Kang J, Bocchino PP, De Ferrari GM, Koo BK, D’Ascenzo F. Two-Year clinical outcomes after coronary bifurcation stenting in older patients from Korea and Italy. Front Cardiovasc Med 2023; 10:1106594. [PMID: 37034327 PMCID: PMC10076885 DOI: 10.3389/fcvm.2023.1106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Older patients who treated by percutaneous coronary intervention (PCI) are at a higher risk of adverse cardiac outcomes. We sought to investigate the clinical impact of bifurcation PCI in older patients from Korea and Italy. Methods We selected 5,537 patients who underwent bifurcation PCI from the BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion regisTries) database. The primary outcome was a composite of target vessel myocardial infarction, clinically driven target lesion revascularization, and stent thrombosis at two years. Results In patients aged ≥75 years, the mean age was 80.1 ± 4.0 years, 65.2% were men, and 33.7% had diabetes. Older patients more frequently presented with chronic kidney disease (CKD), severe coronary calcification, and left main coronary artery disease (LMCA). During a median follow-up of 2.1 years, older patients showed similar adverse clinical outcomes compared to younger patients (the primary outcome, 5.7% vs. 4.5%; p = 0.21). Advanced age was not an independent predictor of the primary outcome (p = 0.93) in overall patients. Both CKD and LMCA were independent predictors regardless of age group. Conclusions Older patients (≥75 years) showed similar clinical outcomes to those of younger patients after bifurcation PCI. Advanced age alone should not deter physicians from performing complex PCIs for bifurcation disease.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Correspondence: Soon Jun Hong
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Giuseppe Patti
- Department of Thoracic and Cardiovascular Diseases, Maggiore Della Carita Hospital, Novara, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
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6
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Bruno F, Marengo G, Filippo OD, Wanha W, Leonardi S, Rubin SR, Fabris E, Giannino G, Truffa A, Gaibazzi N, Ielasi A, Sardella G, Gallone G, Cortese B, Montalto C, Ugo F, Barbieri L, Morici N, Mancone M, Campo G, Sinagra G, D´ascenzo F, De Ferrari GM. 471 IMPACT OF COMPLETE REVASCULARIZATION ON DEVELOPMENT OF HEART FAILURE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND MULTIVESSEL DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The impact of complete revascularization (CR) on survival and occurrence of heart failure (HF) after ACS is still unsettled. Goal of this study was to evaluate the impact of CR on HF hospitalization and adverse outcomes in patients with ACS and multivessel coronary artery disease undergoing PCI.
Methods
Consecutive ACS patients with multivessel disease from the CORALYS registry were included. First hospitalization for HF or cardiovascular (CV) death was the primary endpoint. Patients were stratified according to CR.
Results
Of 14699 patients in the CORALYS registry, 5054 had multivessel disease. 1473 (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary endpoint (adjusted HR 0.66, 95% CI 0.51-0.85), first HF hospitalization (adj HR 0.67, 95% CI 0.49-0.90), CV death (adj HR 0.56, 95% CI 0.38-0.84) and all-cause death (adj HR 0.74, 95% CI 0.56-0.97). The results were consistent in the matched population and in the IPTW analysis. The benefit of CR was consistent across ACS presentations (HR 0.59, 95% CI 0.39-0.89 for STEMI and HR 0.71, 95% CI 0.50-0.99 for NSTE-ACS) and in patients with LVEF>40% (HR 0.52; 95% CI 0.37-0.72), while no significant benefit was observed in patients with LVEF≤40% (HR 0.77; 95% CI 0.37-1.10, p for interaction 0.04).
Conclusions
In patients with ACS and multivessel disease, CR reduced the risk of first hospitalization for HF and CV death, as well as first HF hospitalization, CV and overall death. When feasible, CR should be performed in all patients with ACS to reduce the incidence of HF and death. Future studies are needed to assess the evidence of CR in patients with depressed LVEF.
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Affiliation(s)
- Francesco Bruno
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | - Giorgio Marengo
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | - Ovidio De Filippo
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | - Wojciech Wanha
- Department Of Cardiology, Medical University Of Silesia , Katowice , Poland
| | | | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University Of Trieste , Italy
| | - Giuseppe Giannino
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | | | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital , Parma , Italy
| | | | | | - Guglielmo Gallone
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | | | | | | | - Lucia Barbieri
- Irccs Ca Granda Ospedale Maggiore Policlinico , Milano , Italy
| | | | | | - Gianluca Campo
- Cardiovascular Institute , Azienda Ospedaliera Universitaria Di Ferrara, Cona , Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University Of Trieste , Italy
| | - Fabrizio D´ascenzo
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
| | - Gaetano Maria De Ferrari
- Division Of Cardiology, Cardiovascular And Thoracic Department, Citta Della Salute E Della Scienza Hospital,Turin,Italy
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7
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Januszek R, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Wanha W, Wojakowski W, Bryniarski K, Legutko J, Kambis M, Di Mario C, Bartus K, Bartus S. Procedural outcomes and annual operator volume among patients treated with percutaneous coronary intervention of chronic total occlusions – analysis based on a large national registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It has been demonstrated that low operator and institutional volume is associated with poorer procedural and long-term clinical outcomes in general population of patients treated with percutaneous coronary interventions (PCI).
Purpose
The aim of the current study was to assess the relationship between operator volume and procedural outcomes of patients treated with PCI within chronic total occlusion (CTO).
Methods
Data for conducting the current analysis were obtained from the national registry of percutaneous coronary interventions (ORPKI) maintained in cooperation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study covered data obtained from the registry from January 2014 to December 2020. To investigate the association between operator and all periprocedural complications, coronary artery perforation (CAP) and TIMI flow grade 2/3 after PCI in the presence of confounding and clustering effects, we used multivariable, mixed effects logistic regression modelling.
Results
During the investigated period, there were 162 active CathLabs, at which 747,033 PCI procedures were performed during the time of observation. Of those 14,924 were CTO-PCI procedures. Considering the number of CTO-PCIs performed annually by individual operators during the analyzed 7 years we assessed differences between four groups (≤10; >10≤20; >20≤30 and >30 procedures). We demonstrated by nonlinear relationship with annualised CTO-PCI operator volume that operators performing more than 40 PCI with CTO per year have lower number of the overall periprocedural complications (Fig. 1) including CAP, as well greater procedural success rates (Fig. 2) compared to operators performing less procedures (p<0.0001).
Conclusions
High-volume CTO operators achieve a greater procedural success with a lower frequency of periprocedural complications. This study suggests that the cut-off of 50 CTO-PCIs per year recommended in the EuroCTO Consensus remains a reasonable compromise to optimize outcome and maintain local availability. Special CTO training programs and a higher annual case load might increase the overall quality of CTO PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Januszek
- University Hospital of Krakow , Krakow , Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce , Kielce , Poland
| | | | - S Surowiec
- University Hospital of Krakow , Krakow , Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | | | - J Legutko
- Jagiellonian University , Krakow , Poland
| | - M Kambis
- University Heart Center Freiburg-Bad Krozingen , Bad Krozingen , Germany
| | - C Di Mario
- Careggi University Hospital , Florence , Italy
| | - K Bartus
- Jagiellonian University , Krakow , Poland
| | - S Bartus
- Jagiellonian University , Krakow , Poland
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8
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Wanha W, Tomaniak M, Wańczura P, Bil J, Januszek R, Wolny R, Opolski MP, Kuźma Ł, Milewski M, Lewicki L, Kulczycki J, Iwańczyk S, Sacha J, Janas A, Dziarmaga M, Jaguszewski M, Koltowski L, Olajossy B, Dyrbuś K, Gil R, Bartuś S, Reczuch K, Kochman J, Lesiak M, Wojakowski W. INTRAVASCULAR LITHOTRIPSY FOR THE TREATMENT OF STENT UNDEREXPANSION: THE MULTICENTER IVL-DRAGON REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01594-7] [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: 11/28/2022]
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9
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Angelini F, Franchin L, Bocchino PP, De Filippo O, Morici N, Wanha W, Savonitto S, Trabattoni D, Cerrato E, Barbieri L, De Luca L, Fortuni F, Capodanno D, D'Ascenzo F, De Ferrari GM. In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
Methods
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
Results
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). [Figure 1] After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI 1.03–1.11, p-value <0.001), lower SBP (OR 0.98 per mmHg reduction, 95% CI 1.01–1.03, p-value 0.001) and being not independent at home (OR 2.56, 95% CI 1.25–5.26, p-value 0.01) resulted independent predictors of in-hospital mortality. [Figure 2] A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
Conclusion
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- F Angelini
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - L Franchin
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - P P Bocchino
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - O De Filippo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - N Morici
- Niguarda hospital, Cardiology, Milan, Italy
| | - W Wanha
- University of Silesia, Cardiology, Katowice, Poland
| | - S Savonitto
- Alessandro Manzoni Hospital, Cardiology, Lecco, Italy
| | - D Trabattoni
- Monzino Cardiology Center, IRCCS, Cardiology, Milan, Italy
| | - E Cerrato
- Degli Infermi Hospital, Cardiology, Rivoli, Italy
| | | | - L De Luca
- S. Camillo-Forlanini Hospital, Cardiology, Rome, Italy
| | - F Fortuni
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | | | - F D'Ascenzo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - G M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
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10
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Januszek R, Bil J, Figatowski T, Tomasiewicz B, Desperak P, Niezgoda P, Reczuch K, Kubica J, Gil RJ, Bartus S, Gasior M, Witkowski A, Jaguszewski M, Wojakowski W, Wanha W. Duration of dual antiplatelet therapy and long-term outcomes following drug-eluting balloon or drug-eluting stents for treatment of in-stent restenosis (DAPT-Dragon Registry). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
The aim of the DAPT-DRAGON registry was to asses long-term outcomes and the length of dual antiplatelet therapy (DAPT) in patients treated with percutaneous coronary intervention (PCI) due to drug-eluting stent in stent restenosis (DES-ISR) with drug-eluting balloons (DEB) or thin-DES.
Background
Data regarding the duration of DAPT in patients with DES-ISR treated with PCI is still undergoing research and observation, and the adequate duration of DAPT in this group of patients is not unambiguously sanctioned.
Methods
Overall, 1,367 consecutive patients with DES-ISR who underwent PCI with DEB or DES, were entered into the multi-center DAPT-DRAGON Registry (Fig. 1). The mean age was 66.7±9 years (70.5% males). The median follow-up was 3.3 years. There were 34.1% patients with chronic coronary syndrome, 35.2% with unstable angina, 2.9% with ST segment elevation myocardial infarction and 27.7% with non-ST segment elevation myocardial infarction (MI). We assessed selected study endpoints according to the duration of DAPT (≤3 vs. >3 months and ≤6 vs. >6 months), before and after propensity score matching (PSM): stroke, target lesion revascularization (TLR), target vessel revascularization (TVR), MI, death and device-oriented composite endpoints (DOCE).
Results
Among predictors of increased DOCE rate before PSM, we demonstrated: PCI with DEB vs. DES (p<0.001), recurrent ISR (p=0.002), treatment with glycoprotein IIb/IIIa inhibitor during PCI (p<0.001), lower left ventricle ejection fraction (p=0.004) and extent of stenosis (p<0.001). Pairwise contrast analysis considering type of PCI (thin-DES vs. DEB) and duration of DAPT (≤6 vs. >6 months) before PSM revealed superiority of thin-DES+DAPT >6 months vs. DEB+DAPT >6 months for DOCE (p<0.001), TVR (p=0.02) and TLR (p=0.01). After PSM analysis, the length of DAPT (≤3 vs. >3 months) had no significant influence on assessed long-term outcomes, while the percentage of stroke free survival was significantly lower in the group of patients with DAPT ≤6 months vs. >6 months (p=0.01; Fig. 2).
Conclusions
Long-term treatment with DAPT (>6 months) in patients with DES-ISR with DES implantation is related to better long-term outcomes in terms of lower rate of DOCE, TVR and TLR compared to PCI with DEB. DAPT >6 months is related to a greater rate of strokes, independently of the type of treatment (thin-DES and DEB) compared to DAPT ≤6 months.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- R Januszek
- University Hospital of Krakow, Krakow, Poland
| | - J Bil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | | | - P Desperak
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - P Niezgoda
- Nicolaus Copernicus University, Bydgoszcz, Poland
| | - K Reczuch
- Wroclaw Medical University, Wroclaw, Poland
| | - J Kubica
- Nicolaus Copernicus University, Bydgoszcz, Poland
| | - R J Gil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - M Gasior
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - A Witkowski
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | | | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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11
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Sabatowski K, Malinowski KP, Reczuch K, Dobrzycki S, Lesiak M, Hawranek M, Gil RJ, Witkowski A, Wojakowski W, Lekston A, Gasior M, Wanha W, Legutko J, Bartus S, Januszek R. Gender distribution in patients treated with rotablation – analysis of 5,177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients undergoing percutaneous coronary intervention (PCI) procedures using rotational atherectomy (RA) are a special group of patients characterised by the presence of massive calcifications in the coronary arteries. Due to a significant increase regarding the frequency of these procedures in recent years and the distinctiveness of this narrow group of patients among all patients undergoing PCIs, we have characterised the group according to gender.
Aims
The aim of analysis was to assess the gender percentage share in following years and differences between both groups of Polish patients undergoing PCI with rotational RA between 2014 and 2020.
Methods
Based on the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), we analysed 751,113 patients treated with PCI between 2014 and 2020. Then, we extracted 5,177 (0.7%) treated with PCI and RA, 3,552 of them (68.6%) were males. Selected indices among the two groups were compared using the t-test for continuous variables, the χ2 test or the likelihood-ratio test for nominal variables where appropriate. To compare means of samples in the following years, one-way ANOVA test was used.
Results
The results of the study indicate an upward RA tendency in successive years (p<0.001). Moreover, this tendency and its increase was greater between the years 2016–2019 (Fig. 1). Almost twice as many RA procedures pertain to men, while the percentage share did not undergo a significant change in following years (Fig. 2). The mean age was 72±9 years in the overall group. In the total group, there were 2,873 patients (55.49%) with chronic coronary syndrome, 1,033 (19.95%) with unstable angina, 654 (12.63%) with non-ST segment elevation myocardial infarction (NSTEMI) and 494 (9.54%) with ST segment elevation myocardial infarction (STEMI).
Females were significantly older in comparison to males [75.2±8.3 vs. 70.5±9.2, p<0.001], more often diabetics [613 (37.72%) vs. 1,068 (30.07%), p<0.001], less often smokers [173 (10.6%) vs. 635 (17.9%), p<0.001] and were significantly more often treated due to acute coronary syndrome [780 (48.8%) vs. 1,401 (40.5%), p<0.001]. Considering periprocedural complications among females, there were more cardiac arrests [13 (0.8%) vs. 10 (0.28%), p=0.01] and deaths [11 (0.68%) vs. 6 (0.17%), p=0.006] when compared to males.
Conclusion
The percentage of RA among overall PCIs has been still growing in recent years in Poland. The majority of patients treated with RA are men. Gender distribution did not change significantly among patients treated with PCI and RA during the analysed period of time.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - K Reczuch
- Military Hospital of Wroclaw, Wroclaw, Poland
| | - S Dobrzycki
- Medical University of Bialystok, Bialystok, Poland
| | - M Lesiak
- Poznan University of Medical Sciences, Poznan, Poland
| | - M Hawranek
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - R J Gil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - A Witkowski
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Lekston
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - M Gasior
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - R Januszek
- University Hospital of Krakow, Krakow, Poland
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12
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Kowalowka A, Kowalewski M, Wanha W, Kolodziejczak M, Mariani S, Li T, Stefaniak S, Los A, Hudziak D, Gocol R, Suwalski P, Rogowski J, Jemielity M, Wojakowski W, Deja M. Long-term survival benefit of SAVR over TAVR in low-risk elective patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term.
Purpose
Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis.
Methods
We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).
Results
Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2).
Conclusions
TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2
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Affiliation(s)
- A Kowalowka
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
| | - M Kowalewski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Kolodziejczak
- Nicolaus Copernicus University, Department of Anaesthesiology and Intensive Care, Bydgoszcz, Poland
| | - S Mariani
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - T Li
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - S Stefaniak
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - A Los
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - D Hudziak
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - R Gocol
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - P Suwalski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - J Rogowski
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - M Jemielity
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Deja
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
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13
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Staszczak B, Malinowski KP, Siudak Z, Wanha W, Surdacki A, Wojakowski W, Legutko J, Bartus K, Bartus S, Januszek R. Frequency and predictors of coronary angiography and percutaneous coronary intervention related stroke. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, although potentially life-threatening and often leading to serious disability, characterised by high morbidity and mortality rate. However, particular data on periprocedural complications, predictors, prognosis and the type of coronary intervention has not yet been adequately investigated.
Aim
The aim of the present study was to assess the relationship between the type of coronary procedure [coronary angiography (CA) and PCI] and incidence of stroke as well as predictors of stroke.
Material and methods
This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2019 and included 1,177,161 coronary procedures. Among them, 650,674 patients underwent isolated CA and 526,487 underwent PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) refers to patients admitted for CA and 57 (0.011%) in patients qualified for PCI. Subsequently, the mentioned groups were analysed for similarities and compared. Multivariate analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.
Results
The amount of patients with periprocedural stroke was higher in a group treated with isolated CA during the analysed time. The mean age of the patients, who developed cerebral stroke, was significantly higher in the overall group (71.4±10.6 vs. 66.7±10.8; p<0.001). Patients with stroke, in comparison to non-stroke group, were treated more often from femoral access for CA (p<0.001) and PCI (p=0.04), they had a history of prior stroke for CA (p<0.001) and PCI (p<0.001) more often, and acute myocardial infarction at admission for CA (p<0.001) and PCI (p=0.01). They were also more frequently transported directly to the catheterisation laboratory for CA (p<0.001) and PCI (p=0.002). Predictors of periprocedural stroke, assessed by multivariate analysis for CA, are presented at Fig. 1 and for PCI at Fig. 2.
Conclusions
Based on the large national registry, PCI is associated with fewer risk factors and lower rate of periprocedural strokes than isolated CA.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- B Staszczak
- University Hospital of Krakow, Krakow, Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce, Kielce, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Surdacki
- University Hospital of Krakow, Krakow, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - K Bartus
- Jagiellonian University, Krakow, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - R Januszek
- University Hospital of Krakow, Krakow, Poland
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14
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Navarese EP, Zhang Z, Kubica J, Andreotti F, Farinaccio A, Bartorelli AL, Bedogni F, Rupji M, Tomai F, Giordano A, Reimers B, Spaccarotella C, Wilczek K, Stepinska J, Witkowski A, Grygier M, Kukulski T, Wanha W, Wojakowski W, Lesiak M, Dudek D, Zembala MO, Berti S. Development and Validation of a Practical Model to Identify Patients at Risk of Bleeding After TAVR. JACC Cardiovasc Interv 2021; 14:1196-1206. [PMID: 34112454 DOI: 10.1016/j.jcin.2021.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES No standardized algorithm exists to identify patients at risk of bleeding after transcatheter aortic valve replacement (TAVR). The aim of this study was to generate and validate a useful predictive model. BACKGROUND Bleeding events after TAVR influence prognosis and quality of life and may be preventable. METHODS Using machine learning and multivariate regression, more than 100 clinical variables from 5,185 consecutive patients undergoing TAVR in the prospective multicenter RISPEVA (Registro Italiano GISE sull'Impianto di Valvola Aortica Percutanea; NCT02713932) registry were analyzed in relation to Valve Academic Research Consortium-2 bleeding episodes at 1 month. The model's performance was externally validated in 5,043 TAVR patients from the prospective multicenter POL-TAVI (Polish Registry of Transcatheter Aortic Valve Implantation) database. RESULTS Derivation analyses generated a 6-item score (PREDICT-TAVR) comprising blood hemoglobin and serum iron concentrations, oral anticoagulation and dual antiplatelet therapy, common femoral artery diameter, and creatinine clearance. The 30-day area under the receiver-operating characteristic curve (AUC) was 0.80 (95% confidence interval [CI]: 0.75-0.83). Internal validation by optimism bootstrap-corrected AUC was 0.79 (95% CI: 0.75-0.83). Score quartiles were in graded relation to 30-day events (0.8%, 1.1%, 2.5%, and 8.5%; overall p <0.001). External validation produced a 30-day AUC of 0.78 (95% CI: 0.72-0.82). A simple nomogram and a web-based calculator were developed to predict individual patient probabilities. Landmark cumulative event analysis showed greatest bleeding risk differences for top versus lower score quartiles in the first 30 days, when most events occurred. Predictivity was maintained when omitting serum iron values. CONCLUSIONS PREDICT-TAVR is a practical, validated, 6-item tool to identify patients at risk of bleeding post-TAVR that can assist in decision making and event prevention.
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Affiliation(s)
- Eliano Pio Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; SIRIO MEDICINE Research Network, Bydgoszcz, Poland.
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Felicita Andreotti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Farinaccio
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Manali Rupji
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Bernard Reimers
- Division of Cardiology, CCU and Interventional, Cardiology, Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | - Krzysztof Wilczek
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | | | | | | | - Tomasz Kukulski
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michal O Zembala
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
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15
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Hudziak D, Hajder A, Gocol R, Malinowski M, Kazmierski M, Morkisz L, Ciosek J, Wanha W, Jarosinski G, Parma R, Darocha T, Wojakowski W. Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry. J Clin Med 2021; 10:1499. [PMID: 33916515 PMCID: PMC8038472 DOI: 10.3390/jcm10071499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Adrianna Hajder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Maciej Kazmierski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Lukasz Morkisz
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Joanna Ciosek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Grzegorz Jarosinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
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16
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Koni E, Wanha W, Ratajczak J, Zhang Z, Podhajski P, Musci RL, Sangiorgi GM, Kaźmierski M, Buffon A, Kubica J, Wojakowski W, Navarese EP. Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. J Clin Med 2021; 10:jcm10061278. [PMID: 33808678 PMCID: PMC8003362 DOI: 10.3390/jcm10061278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54-0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58-0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42-0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53-0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.
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Affiliation(s)
- Endrin Koni
- Department of Interventional Cardiology, Santa
Corona Hospital, 17027 Pietra Ligure, Italy;
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Department of Health Promotion, Nicolaus Copernicus
University, 87100 Bydgoszcz, Poland
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw
Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
- Key Laboratory of Emergency and Trauma, Ministry of
Education, College of Emergency and Trauma, Hainan Medical University, Haikou 571199,
China
| | - Przemysław Podhajski
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Rita L. Musci
- Department of Biomedicine and Prevention,
University of Rome Tor Vergata, 00173 Rome, Italy;
| | - Giuseppe M. Sangiorgi
- Cardiac Cath Lab, Department of Cardiology, San
Gaudenzio Clinic, 28100 Novara, Italy;
| | - Maciej Kaźmierski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Antonio Buffon
- Institute of Cardiology, Catholic University of
the Sacred Heart Rome, 00168 Rome, Italy;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Eliano P. Navarese
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Faculty of Medicine, University of Alberta,
Edmonton, AB 13103, Canada
- Correspondence:
; Tel.: +48-52-585-4023; Fax:
+48-52-585-4024
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17
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Abstract
Primary percutaneous coronary intervention is the preferred reperfusion strategy for the management of acute ST-segment elevation myocardial infarction. No reflow is characterized by the inadequate myocardial perfusion of a given segment without angiographic evidence of persistent mechanical obstruction of epicardial vessels. Both pharmacologic and device-based strategies have been tested to resolve coronary no reflow. This article provides an updated overview of the no-reflow phenomenon, discussing clinical evidence and ongoing investigations of existing and novel therapeutic strategies to counteract it.
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Affiliation(s)
- Gianluca Caiazzo
- ICCU, San Giuseppe Moscati Hospital, ASL CE, Via Gramsci 1, Aversa 81031, Italy
| | - Rita Leonarda Musci
- Department of Cardiology, Azienda Ospedaliera Bonomo, Viale Istria, Andria BT 76123, Italy
| | - Lara Frediani
- Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Viale Vittorio Alfieri, 36, Livorno LI 57124, Italy
| | - Julia Umińska
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, ul. Józefa Poniatowskiego 15, Kato 40-055, Katowice, Poland
| | - Krzysztof J Filipiak
- Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, Warszawa 02-091, Poland
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Eliano Pio Navarese
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland; University of Alberta, 116 Street & 85 Avenue, Edmonton, AB T6G 2R3, Canada.
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18
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Montefusco A, De Filippo O, Gili S, Mancone M, Calcagno S, Cirillo P, Esposito G, Poli A, Ferrara E, Smolka G, Wanha W, Palmieri C, Pastormerlo LE, Baumbach A, Sganzerla P, Tamburino C, Bruno F, Secco GG, Nicolino A, Yew KL, di Palma G, Wojakowski W, Sardella G, Rinaldi M, Cortese B, D'Ascenzo F. Safety and effectiveness of the self-aPposing, bAlloon-delivered, siRolimus-eluting stent for the Treatment of the coronary Artery disease: SPARTA, a multicenter experience. Coron Artery Dis 2019; 31:27-34. [PMID: 31658146 DOI: 10.1097/mca.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To assess the long-term outcomes of patients treated with sirolimus-eluting Stentys stent in a real-life setting. BACKGROUND Few data regarding the safety and effectiveness of self-apposing sirolimus-eluting Stentys stent are available. METHODS 278 patients (30% stable coronary artery disease, 70% acute coronary syndromes, and 54% on unprotected left main) treated with sirolimus eluting Stentys stent were retrospectively included in the self-aPposing, bAlloon-delivered, siRolimus-eluting stent for the Treatment of the coronary Artery disease multicenter registry. Major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, target lesion revascularization, stent thrombosis) were the primary end-point, single components of MACE were the secondary ones. RESULTS After 13 months (interquartile range 5-32), MACE was 14%. Stent thrombosis occurred in 3.9% of the patients (2.5% definite stent thrombosis and 1.4% probable stent thrombosis), 66% of them presenting with ST-segment elevation myocardial infarction (STEMI) at admission. Cardiovascular death, target lesion revascularization and myocardial infarction was 4.7%, 8.3%, and 7.2%, respectively. At multivariate analysis, risk of MACE was increased by diabetes (hazard ratios 4.76; P = 0.002) but was not affected by the indication leading to sirolimus-eluting Stentys stent implantation (marked vessel tapering vs. coronary ecstasies, hazard ratios 0.74, P = 0.71). CONCLUSION Sirolimus-eluting Stentys stent may represent a potential solution for specific coronary anatomies such as bifurcation, ectasic, or tapered vessels. Risk of stent thrombosis appears related to clinical presentation with STEMI and to anatomic features, stressing the importance of the use of intracoronary imaging for self-expandable stents implantation.
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Affiliation(s)
- Antonio Montefusco
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Ovidio De Filippo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Sebastiano Gili
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Simone Calcagno
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Arnaldo Poli
- Division of Cardiology, Ospedale Civile di Legnano - ASST Ovest Mi, Legnano, Italy
| | - Erika Ferrara
- Division of Cardiology, Ospedale Civile di Legnano - ASST Ovest Mi, Legnano, Italy
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Paolo Sganzerla
- Division of Cardiology, AO Ospedale Treviglio-Caravaggio, Treviglio
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania
| | - Francesco Bruno
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria
| | | | - Kuang Leon Yew
- Cardiology Department, Manipal Hospital, Klang, Selangor, Malaysia
| | - Gaetano di Palma
- Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Mauro Rinaldi
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Bernardo Cortese
- Fondazione Monasterio CNR-Regione Toscana, Massa, Italy.,Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
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19
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Abdirashid M, D'Ascenzo F, Helft G, Boccuzzi G, Capodanno D, Giustetto C, Muscoli S, Wojakowski W, Wanha W, Protasiewicz M, Smolka G, Huczek Z, Kuliczowki W, Chieffo A, Rinaldi M. P972A subgroup analysis from the RAIN-CARDIOGROUP VII study: incidence of adverse events after DAPT cessation in patients treated with ultrathin stents in ULM or coronary bifurcations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Incidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with ultrathin stents in unprotected left main (ULM) or coronary bifurcation remain undefined.
Methods
All consecutive patients presenting with a critical lesion of an ULM or a lesion involving a main coronary bifurcation and treated with very thin strut stents were included. MACE (a composite end point of cardiovascular death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) was the primary endpoint, while target vessel revascularization (TVR) was the secondary endpoint. Moreover, type and occurrence of ST and occurrence of ST, CV death and MI during DAPT or after DAPT discontinuation were also evaluated. All analyses were performed according to length of DAPT dividing the patients in 3 groups: short DAPT (3-months), intermediate DAPT (3–12 months) and long DAPT (12-months).
Results
117 patients were discharged with an indication for DAPT≤3 months (median 1:1–2.5), 200 for DAPT between 3 and 12 months (median 8:7–10) and 1958 with 12 months DAPT. After 12.8 months (8–20), MACE was significantly higher in the 3-month group compared to 3–12 and 12-month groups (9.4% vs. 4.0% vs. 7.2%, p≤0.001), mainly driven by MI (4.4% vs. 1.5% vs. 3%, p≤0.001) and overall ST (4.3% vs. 1.5% vs. 1.8%, p≤0.001). ST post DAPT cessation were comparable (1.7% vs. 0% vs. 0.7%, p=0.42) with a median time to ST post DAPT discontinuation of 1.67 months (0.48–4.7). At multivariate analysis, DAPT of 12-months compared to 3-months reduces the risk of overall ST (OR 0.103: 0.019–0.0563, 95% CI) while only a trend was noted for DAPT between 3 and 12 months (OR 0.61: 0.186–2.005, 95% CI). When analysed by stent strategy a 2-stent strategy predicted ST post DAPT cessation (OR 3.241: 1.048–10.026, 95% CI), which was reduced by use of FKB (OR 0.101:0.01–0.872, 95% CI).
Conclusion
Even stents with very thin strut when implanted in real-life ULM or coronary bifurcation patients discharged with short DAPT have a relevant risk of ST, which remains high although not significant after DAPT cessation. The correct identification before PCI of the more fragile patients who may receive a shorter DAPT regimen could help identify the safest PCI technique: provisional stenting and use of final kissing balloon (FKB) are the safest options.
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Affiliation(s)
- M Abdirashid
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - G Helft
- University Pierre & Marie Curie Paris VI, Cardiology, Paris, France
| | - G Boccuzzi
- San Giovanni Bosco Hospital of Turino, Cardiology, Turin, Italy
| | - D Capodanno
- University Hospital Vittorio Emanuele, Cardiology, Catania, Italy
| | - C Giustetto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - S Muscoli
- San Raffaele Hospital of Milan (IRCCS), Cardiology, Milan, Italy
| | - W Wojakowski
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - W Wanha
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - M Protasiewicz
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - G Smolka
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - Z Huczek
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - W Kuliczowki
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - A Chieffo
- San Raffaele Hospital of Milan (IRCCS), Cardiology, Milan, Italy
| | - M Rinaldi
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
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Navarese EP, Andreotti F, Kołodziejczak M, Wanha W, Lauten A, Veulemans V, Frediani L, Kubica J, de Cillis E, Wojakowski W, Ochala A, Zeus T, Bortone A, Buffon A, Jung C, Pestrichella V, Gurbel PA. Age-Related 2-Year Mortality After Transcatheter Aortic Valve Replacement: the YOUNG TAVR Registry. Mayo Clin Proc 2019; 94:1457-1466. [PMID: 30824280 DOI: 10.1016/j.mayocp.2019.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/25/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To comparatively assess the natural history of patients of different ages undergoing transcatheter aortic valve replacement (TAVR). PATIENTS AND METHODS For this study, we used the YOUNG TAVR, an international, multicenter registry investigating mortality trends up to 2 years in patients with aortic valve stenosis treated by TAVR, classified according to 3 prespecified age groups: 75 years or younger (n=179), 76 to 86 years (n=602), and older than 86 years (n=221). A total of 1002 patients undergoing TAVR were included. Demographic, clinical, and outcome data in the youngest group were compared with those of patients 76 to 86 years and older than 86 years. Patients were followed up for up to 2 years. RESULTS Compared with patients 75 years or younger (reference group), patients aged 76 to 86 years and older than 86 years had nonsignificantly different 30-day mortality (odds ratio, 0.76; 95% CI, 0.41-1.38; P=.37 and odds ratio, 1.27; 95% CI, 0.62-2.60; P=.51, respectively) and 1-year mortality (hazard ratio (HR), 0.72; 95% CI, 0.48-1.09; P=.12 and HR, 1.11; 95% CI, 0.88-1.40; P=.34, respectively). Mortality at 2 years was significantly lower among patients aged 76 to 86 years (HR, 0.62; 95% CI, 0.42-0.90; P=.01) but not among the older group (HR, 1.06; 95% CI, 0.68-1.67; P=.79). The Society of Thoracic Surgeons 30-day mortality score was lower in younger patients who, however, had a significantly higher prevalence of chronic obstructive pulmonary disease (P=.005 vs the intermediate group and P=.02 vs the older group) and bicuspid aortic valves (P=.02 vs both older groups), larger left ventricles, and lower ejection fractions. CONCLUSION In the present registry, mortality at 2 years after TAVR among patients 75 years or younger was higher compared with that of patients aged 75 to 86 years and was not markedly different from that of patients older than 86 years. The findings are attributable at least in part to a greater burden of comorbidities in the younger age group that are not entirely captured by current risk assessment tools.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Felicita Andreotti
- Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy
| | - Michalina Kołodziejczak
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wojciech Wanha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alexander Lauten
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Department of Cardiology, Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Lara Frediani
- Department of Cardiology, Azienda Usl Toscana Nord-Ovest Cardiologia UTIC ed Emodinamica-Ospedali Riuniti di Livorno, Italy
| | - Jacek Kubica
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Emanuela de Cillis
- Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy
| | - Wojciech Wojakowski
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Ochala
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Alessandro Bortone
- Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy
| | - Antonio Buffon
- Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Vincenzo Pestrichella
- Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy
| | - Paul A Gurbel
- INOVA Heart and Vascular Institute, Fairfax, VA; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Montefusco A, D'Ascenzo F, Gili S, Smolka G, Chieffo A, Baumbach A, Escaned J, Sganzerla P, Tomassini F, Secco GG, Ugo F, Tamburino C, Nicolino A, Mancone M, Poli A, Yew KL, Cirillo P, Wanha W, Pastormerlo LE, di Summa R, Sardella G, Colombo A, Gaita F, Cortese B. Self-expandable sirolimus-eluting stents compared to second-generation drug-eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS-2 registries. Catheter Cardiovasc Interv 2019; 93:208-215. [PMID: 30298593 DOI: 10.1002/ccd.27809] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 07/02/2018] [Accepted: 07/12/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare the effectiveness and safety of self-expandable, sirolimus-eluting Stentys stents (SES) and second-generation drug-eluting stents (DES-II) for the treatment of the unprotected left main (ULM). BACKGROUND SES may provide a valuable option to treat distal ULM, particularly when significant caliber gaps with side branches are observed. METHODS Patients from the multicenter SPARTA (clinicaltrials.gov: NCT02784405) and FAILS2 registries were included. Propensity-score with matching was performed to account for the lack of randomization. Primary end-point was the rate of major adverse cardiovascular events (MACE, a composite of all cause death, myocardial infarction, target lesion revascularization [TLR], unstable angina and definite stent thrombosis [ST]). Single components of MACE were the secondary end-points. RESULTS Overall, 151 patients treated with SES and 1270 with DES-II were included; no differences in MACE rate at 250 days were observed (9.8% vs. 11.5%, P = 0.54). After propensity score with matching, 129 patients treated with SES and 258 with DES-II, of which about a third of female gender, were compared. After a follow-up of 250 days, MACE rate did not differ between the two groups (9.9% vs. 8.5%, P = 0.66), as well as the rate of ULM TLR (1.6% vs. 3.1%, P = 0.36) and definite ST (0.8% vs. 1.2%, P = 0.78). These results were consistent also when controlling for the treatment with provisional vs. 2-stents strategies for the ULM bifurcation. CONCLUSION SES use for ULM treatment was associated with a similar MACE rate compared to DES-II at an intermediate-term follow-up. SES might represent a potential option in this setting.
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Affiliation(s)
- Antonio Montefusco
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sebastiano Gili
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Grzegorz Smolka
- Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Paolo Sganzerla
- Division of Cardiology, AO Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - Francesco Tomassini
- Interventional Cardiology Unit, Infermi Hospital, Rivoli and San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Fabrizio Ugo
- Division of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Massimo Mancone
- Department of Cardiovascular Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Arnaldo Poli
- Division of Cardiology, Ospedale Civile di Legnano - ASST Ovest Mi, Legnano, Italy
| | - Kuan-Leong Yew
- Cardiology Department, Manipal Hospital, Klang, Selangor, Malaysia
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Wojciech Wanha
- Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Roberto di Summa
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy.,Fondazione Monasterio CNR-Regione Toscana, Italy
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Navarese EP, Wernly B, Lichtenauer M, Petrescu AM, Kołodziejczak M, Lauten A, Frediani L, Veulemanns V, Wanha W, Wojakowski W, Lesiak M, Ferrante G, Zeus T, Tantry U, Bliden K, Buffon A, Contegiacomo G, Jung C, Kubica J, Pestrichella V, Gurbel PA. Dual vs single antiplatelet therapy in patients with lower extremity peripheral artery disease – A meta-analysis. Int J Cardiol 2018; 269:292-297. [DOI: 10.1016/j.ijcard.2018.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/24/2018] [Accepted: 07/02/2018] [Indexed: 01/22/2023]
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24
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Veulemanns V, Wanha W, Kubica J, De Cillis E, Bortone AS, Pestrichella V, Zeus T, Jung C, Lauten A, Kelm M, Bliden K, Tantry U, Wojakowski W, Gurbel PA, Navarese EP. P1674Vascular Complications with Transcatheter Aortic Valve Replacement devices. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Veulemanns
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - W Wanha
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - J Kubica
- Collegium Medicum, Department of Cardiology Nicolaus Copernicus University, Bydgoszcz, Poland
| | - E De Cillis
- A.O.U. Policlinico Consorziale, U.O.C. Cardiologia Ospedaliera, Bari, Italy
| | - A S Bortone
- University of Bari, Department of Interventional Cardiology, Bari, Italy
| | | | - T Zeus
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - C Jung
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - A Lauten
- Campus Benjamin Franklin, Charité, Department of Cardiology, Berlin, Germany
| | - M Kelm
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - K Bliden
- Sinai Hospital of Baltimore, Sinai Center for Thrombosis Research, Baltimore, United States of America
| | - U Tantry
- Sinai Hospital of Baltimore, Sinai Center for Thrombosis Research, Baltimore, United States of America
| | - W Wojakowski
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - P A Gurbel
- Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development, Fairfax, Virginia, United States of America
| | - E P Navarese
- Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development, Fairfax, Virginia, United States of America
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Veulemans V, Wanha W, Lauten A, De Cillis E, Bortone AS, Pestrichella V, Zeus T, Jung C, Ochala A, Gurbel PA, Wojakowski W, Kelm M, Kubica J, Navarese EP. P4581Short- and long-term mortality in patients with diabetes mellitus after TAVR: Results of an international multicenter registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Veulemans
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - W Wanha
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - A Lauten
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - E De Cillis
- Polyclinic Hospital of Bari, U.O.C. Cardiologia Ospedaliera, A.O.U., Bari, Italy
| | - A S Bortone
- University of Bari, Department of Interventional Cardiology, Bari, Italy
| | | | - T Zeus
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - C Jung
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - A Ochala
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - P A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Interventional Cardiology and Cardiovascular Medicine Research, Falls Church, VA, United States of America
| | - W Wojakowski
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Kelm
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - J Kubica
- Nicolaus Copernicus University (NCU), Department of Cardiology, Bydgoszcz, Poland
| | - E P Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Interventional Cardiology and Cardiovascular Medicine Research, Falls Church, VA, United States of America
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26
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Jadczyk T, Baranski K, Syzdol M, Nabialek E, Wanha W, Kurzelowski R, Ratajczak MZ, Kucia M, Dolegowska B, Niewczas M, Zejda J, Wojakowski W. Bioactive Sphingolipids, Complement Cascade, and Free Hemoglobin Levels in Stable Coronary Artery Disease and Acute Myocardial Infarction. Mediators Inflamm 2018; 2018:2691934. [PMID: 30116144 PMCID: PMC6079520 DOI: 10.1155/2018/2691934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery are associated with a pathogen-free inflammatory response (sterile inflammation). Complement cascade (CC) and bioactive sphingolipids (BS) are postulated to be involved in this process. AIM The aim of this study was to evaluate plasma levels of CC cleavage fragments (C3a, C5a, and C5b9), sphingosine (SP), sphingosine-1-phosphate (S1P), and free hemoglobin (fHb) in AMI patients treated with primary percutaneous coronary intervention (pPCI) and stable coronary artery disease (SCAD) undergoing CABG. PATIENTS AND METHODS The study enrolled 37 subjects (27 male) including 22 AMI patients, 7 CABG patients, and 8 healthy individuals as the control group (CTRL). In the AMI group, blood samples were collected at 5 time points (admission to hospital, 6, 12, 24, and 48 hours post pPCI) and 4 time points in the CABG group (6, 12, 24, and 48 hours post operation). SP and S1P concentrations were measured by high-performance liquid chromatography (HPLC). Analysis of C3a, C5a, and C5b9 levels was carried out using high-sensitivity ELISA and free hemoglobin by spectrophotometry. RESULTS The plasma levels of CC cleavage fragments (C3a and C5b9) were significantly higher, while those of SP and S1P were lower in patients undergoing CABG surgery in comparison to the AMI group. In both groups, levels of CC factors showed no significant changes within 48 hours of follow-up. Conversely, SP and S1P levels gradually decreased throughout 48 hours in the AMI group but remained stable after CABG. Moreover, the fHb concentration was significantly higher after 24 and 48 hours post pPCI compared to the corresponding postoperative time points. Additionally, the fHb concentrations increased between 12 and 48 hours after PCI in patients with AMI. CONCLUSIONS Inflammatory response after AMI and CABG differed regarding the release of sphingolipids, free hemoglobin, and complement cascade cleavage fragments.
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Affiliation(s)
- T. Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - K. Baranski
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - M. Syzdol
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - E. Nabialek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - W. Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - R. Kurzelowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - M. Z. Ratajczak
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, USA
| | - M. Kucia
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, USA
| | - B. Dolegowska
- Department of Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - M. Niewczas
- Department of Sport, Faculty of Physical Education, University of Rzeszow, Rzeszow, Poland
| | - J. Zejda
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - W. Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
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27
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Navarese EP, Kołodziejczak M, Petrescu A, Wernly B, Lichtenauer M, Lauten A, Buffon A, Wanha W, Pestrichella V, Sardella G, Contegiacomo G, Tantry U, Bliden K, Kubica J, Gurbel PA. Role of proprotein convertase subtilisin/kexin type 9 inhibitors in patients with coronary artery disease undergoing percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2018; 16:419-429. [DOI: 10.1080/14779072.2018.1474099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Eliano P. Navarese
- SIRIO MEDICINE Cardiovascular research network, Fairfax, VA, USA
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA
| | - Michalina Kołodziejczak
- SIRIO MEDICINE Cardiovascular research network, Fairfax, VA, USA
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Aniela Petrescu
- Universitaire Ziekenhuis Gasthuisberg Leuven, Leuven, Belgium
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Saltzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Saltzburg, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany
| | - Antonino Buffon
- Catholic University Medical School, Institute of Cardiology, Rome, Italy
| | - Wojciech Wanha
- Department of Cardiology, School of Health Sciences Medical University of Silesia in Katowice, Katowice, Poland
| | - Vincenzo Pestrichella
- Department of Cardiology, Interventional Cardiology Unity, Mater Dei Hospital, Bari, Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Udaya Tantry
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA
| | - Kevin Bliden
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA
| | - Jacek Kubica
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA
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28
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Navarese EP, Wernly B, Lichtenauer M, Pepe M, Wanha W, Ferrante G, Frediani L, Veulemans V, Zeus T, Westenfeld R, Jung C, Gurbel PA. Prime time for the sweet spot in timing of coronary invasive approach in patients with non-ST elevation myocardial infarction. J Thorac Dis 2018; 10:17-20. [PMID: 29600012 DOI: 10.21037/jtd.2017.11.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eliano P Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA.,SIRIO MEDICINE Cardiovascular research network, VA, USA
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Martino Pepe
- Department of Emergency and Organ Transplant, Cardiology Unit, Bari University Hospital, Bari, Italy
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart DiseasesMedical University of Silesia, Katowice, Poland
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy
| | - Lara Frediani
- Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA.,SIRIO MEDICINE Cardiovascular research network, VA, USA
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Wanha W, Mielczarek M, Smolka G, Roleder T, Jaguszewski M, Chmielecki M, Bartus S, Sukiennik A, Kubica J, Lekston A, Hawranek M, Reczuch K, Ochala A, Wojakowski W. TCT-832 Treatment of left main coronary artery stenosis with the STENTYS self-expandable drug-eluting stent – a multicenter registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1042] [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: 10/18/2022]
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Roleder T, Dobrolińska M, Pociask E, Wanha W, Smolka G, Bochenek T, Walkowicz W, Lebek M, Parma R, Ochala A, Gasior Z, Tendera M, Wojakowski W. TCT-581 Plaque redistribution after stenting: data from NIRS-IVUS imaging. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.719] [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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Wanha W, Kawecki D, Roleder T, Pluta A, Marcinkiewicz K, Morawiec B, Kret M, Pawlowski T, Smolka G, Ochala A, Wojakowski W. Gender differences and bleeding complications after PCI on first and second generation DES. SCAND CARDIOVASC J 2016; 51:53-60. [PMID: 27471987 DOI: 10.1080/14017431.2016.1219044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate gender differences in the long-term clinical outcomes and safety of patients treated with first- and second generation DES. METHODS The Katowice-Zabrze Registry included 1916 consecutive patients treated with either first or second generation DES. We evaluated major adverse cardiac and cerebrovascular events (MACCE) [composite of death, myocardial infarction (MI), stroke and target vessel revascularization (TVR)] at 12-month follow-up. Safety end point was bleeding complications and stent thrombosis. RESULTS Registry included [unstable angina (UA) 1500(78%), non-ST-segment elevation myocardial infarction (NSTEMI) 285 (15%), ST-segment elevation myocardial infarction/left bundle branch block (STEMI/LBBB) 131 (7%)]. There were 35.5% females and 64.5% males. Women were older and had higher prevalence of comorbidities. Males more often had multivessel disease and higher Syntax score when comparable to females. We did not observed difference in acute and subacute stent thrombosis in our data, however, females had more in-hospital bleeding complications. Univariable Cox regression analysis revealed that women had similar outcomes when compared to men in terms of a risk of death, MI, TVR, stroke and MACCE at 1-year follow-up. There were no differences between males and females in MACCE when first- and second generation DES were analyzed separately. CONCLUSION Despite higher risk profile, women treated with DES have similar outcomes as males in 1-year follow-up. However there is, an increased risk of in-hospital bleedings in women.
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Affiliation(s)
- Wojciech Wanha
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Damian Kawecki
- b Division of Cardiology , Medical University of Silesia , Zabrze , Poland
| | - Tomasz Roleder
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Aleksandra Pluta
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Kamil Marcinkiewicz
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Beata Morawiec
- b Division of Cardiology , Medical University of Silesia , Zabrze , Poland
| | - Mariusz Kret
- c Department of Cardiology , Specialistic Hospital , Tarnow , Poland
| | - Tomasz Pawlowski
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Grzegorz Smolka
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Andrzej Ochala
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
| | - Wojciech Wojakowski
- a Third Division of Cardiology , Medical University of Silesia , Katowice , Poland
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Milewski K, Fil W, Buszman P, Janik M, Wanha W, Martin T, Król M, Gorycki B, Wiernek S, Krzych L, Kiesz RS, Wojakowski W, Buszman P. Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up. Kidney Blood Press Res 2016; 41:278-87. [DOI: 10.1159/000443423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
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Kawecki D, Morawiec B, Dola J, Wanha W, Smolka G, Pluta A, Marcinkiewicz K, Ochała A, Nowalany-Kozielska E, Wojakowski W. First- Versus Second-Generation Drug-Eluting Stents in Acute Coronary Syndromes (Katowice-Zabrze Registry). Arq Bras Cardiol 2016; 106:373-81. [PMID: 27058257 PMCID: PMC4914001 DOI: 10.5935/abc.20160043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/25/2015] [Accepted: 01/06/2016] [Indexed: 12/03/2022] Open
Abstract
Background There are sparse data on the performance of different types of drug-eluting
stents (DES) in acute and real-life setting. Objective The aim of the study was to compare the safety and efficacy of first- versus
second-generation DES in patients with acute coronary syndromes (ACS). Methods This all-comer registry enrolled consecutive patients diagnosed with ACS and
treated with percutaneous coronary intervention with the implantation of
first- or second-generation DES in one-year follow-up. The primary efficacy
endpoint was defined as major adverse cardiac and cerebrovascular event
(MACCE), a composite of all-cause death, nonfatal myocardial infarction,
target-vessel revascularization and stroke. The primary safety outcome was
definite stent thrombosis (ST) at one year. Results From the total of 1916 patients enrolled into the registry, 1328 patients
were diagnosed with ACS. Of them, 426 were treated with first- and 902 with
second-generation DES. There was no significant difference in the incidence
of MACCE between two types of DES at one year. The rate of acute and
subacute ST was higher in first- vs. second-generation DES (1.6% vs. 0.1%, p
< 0.001, and 1.2% vs. 0.2%, p = 0.025, respectively), but there was no
difference regarding late ST (0.7% vs. 0.2%, respectively, p = 0.18) and
gastrointestinal bleeding (2.1% vs. 1.1%, p = 0.21). In Cox regression,
first-generation DES was an independent predictor for cumulative ST (HR 3.29
[1.30-8.31], p = 0.01). Conclusions In an all-comer registry of ACS, the one-year rate of MACCE was comparable
in groups treated with first- and second-generation DES. The use of
first-generation DES was associated with higher rates of acute and subacute
ST and was an independent predictor of cumulative ST.
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Affiliation(s)
- Damian Kawecki
- 2, Zabrze Medical University of Silesia, Katowice, Poland
| | - Beata Morawiec
- 2, Zabrze Medical University of Silesia, Katowice, Poland
| | - Janusz Dola
- 2, Zabrze Medical University of Silesia, Katowice, Poland
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Wanha W, Roleder T, Ladzinski S, Gladysz S, Smolka G, Ochala A, Tendera M, Wojakowski W. TCTAP A-080 First and Second Generation Drug Eluting Stents Versus Bare Metal Stents in All Comer Population of Patients Undergoing PCI of Saphenous Vein Graft in 1-Year Follow-up. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.03.103] [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: 11/27/2022]
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Roleder T, Skowerski M, Wiecek A, Adamczak M, Czerwienska B, Wanha W, Jadczyk T, Partyka L, Smolka G, Kuczmik W, Ochała A, Dudek D, Tendera M, Gasior Z, Wojakowski W. Long-term follow-up of renal arteries after radio-frequency catheter-based denervation using optical coherence tomography and angiography. Int J Cardiovasc Imaging 2016; 32:855-62. [PMID: 26883432 DOI: 10.1007/s10554-016-0853-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
Optical coherence tomography (OCT) imaging at the time of renal denervation (RDN) showed that procedure might cause spasm, intimal injury or thrombus formation. In the present study, we assessed the healing of renal arteries after RDN using OCT and renal angiography in long-term follow-up. OCT and renal angiography were performed in 12 patients (22 arteries) 18.41 ± 5.83 months after RNS. There were no adverse events or complications during the long-term follow-up. In ten patients (83 %), significant reductions of blood pressure was achieved without a change of the antihypertensive medications. We demonstrated the presence of 26 areas of focal intimal thickening identified by OCT in 10 (83 %) patients and in 14 (63 %) arteries. The mean area of focal intimal thickening was 0.054 ± 0.033 mm(2). No vessel dissection, thrombus, intimal tear or acute vasospasm were observed during the OCT analysis. Also, the quantitative angiography analysis revealed a significant reduction of the minimal and proximal lumen diameters at follow-up as compared to measurements obtained before RDN. Renal arteries have a favorable "long-term" vessel healing response after RDN. Focal intimal thickening and a modest reduction of the minimal lumen diameter may be observed after RF denervation. Further studies are needed to determine whether intravascular imaging may be helpful in evaluating the vessel healing of RF RDN.
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Affiliation(s)
- Tomasz Roleder
- Chair and Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland.
| | - Mariusz Skowerski
- Chair and Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Andrzej Wiecek
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Marcin Adamczak
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Beata Czerwienska
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Wojciech Wanha
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Tomasz Jadczyk
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Lukasz Partyka
- Krakow Cardiovascular Research Institute, 5 Miechowska Street, 30-055, Krakow, Poland
| | - Grzegorz Smolka
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Wacław Kuczmik
- Division of Vascular Surgery, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Andrzej Ochała
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka Street, 31-202, Krakow, Poland
| | - Michał Tendera
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Zbigniew Gasior
- Chair and Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
| | - Wojciech Wojakowski
- Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland
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Wojakowski W, Wanha W, Roleder T, Ochala B, Dola J, Morawiec B, Pluta A, Marcinkiewicz K, Ochala A, Kawecki D, Tendera M. USE OF SECOND GENERATION DES DOES NOT IMPROVE THE LONG-TERM OUTCOME IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN COMPARISON TO FIRST GENERATION DES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61874-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: 11/29/2022]
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Wojakowski W, Wanha W, Pluta A, Marcinkiewicz K, Dola J, Kawecki D, Morawiac B, Krzych L, Ochala A, Tendera M. TCTAP A-075 Prognostic Significance of Anemia in Patients Undergoing PCI with First and Second Generation DES (Katowice Registry). J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.092] [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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