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Kuno T, Claessen BE, Guedeney P, Serruys PW, Sabik JF, Simonton CA, Kandzari DE, Morice MC, Zhang Z, Dressler O, Mehran R, Ben-Yehuda O, Kappetein AP, Stone GW. Outcomes of Vascular Closure Device Use After Transfemoral Coronary Intervention: Insights From the EXCEL Trial. J Invasive Cardiol 2021; 33:E619-E627. [PMID: 34170842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of using vascular closure devices (VCDs) in percutaneous coronary intervention (PCI) for left main coronary artery disease (LM-CAD). BACKGROUND VCDs provide rapid hemostasis for patients undergoing PCI with transfemoral access (TFA); however, the safety and efficacy of VCDs continues to be debated. METHODS We analyzed data from the EXCEL trial in patients with LM-CAD in whom PCI was performed via TFA with vs without VCD. The primary endpoint was a composite of death, myocardial infarction (MI), or stroke. Bleeding Academic Research Consortium (BARC) type 2-5 bleeding at 30 days was also assessed. Propensity-score matching analysis was used. RESULTS Among 694 patients with LM-CAD undergoing TFA-PCI, 423 (61.0%) received VCDs (collagen plug, 320 [75.7%]; suture mediated, 55 [13.0%]; others, 48 [11.3%]). Patients with and without VCD use had similar 30-day rates of BARC type 2-5 bleeding (5.0% vs 6.7%, respectively; P=.30) and BARC type 3-5 bleeding (2.1% vs 3.7%, respectively; P=.20). There were no significant differences in the rates of death, MI, or stroke in patients with and without VCD use at 30 days (4.7% vs 4.1%, respectively; P=.74) or at 5 years (20.3% vs 24.2%, respectively; P=.16). These results were similar after adjustment. CONCLUSION In the EXCEL trial, LM-CAD PCI via TFA using VCD was associated with similar 30-day rates of bleeding and comparable early and late major adverse cardiovascular events compared with manual compression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gregg W Stone
- Mount Sinai Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019 USA.
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Brener SJ, Lembo NJ, Kandzari DE, Sabaté M, Gershlick AH, Banning AP, Buszman PE, Kosmidou I, Simonton CA, Morice MC, Ben-Yehuda O, Dressler O, Zhang Z, Sabik JF, Kappetein AP, Serruys PW, Stone GW. Antithrombotic regimens for percutaneous coronary intervention of the left main coronary artery: The EXCEL trial. Catheter Cardiovasc Interv 2021; 97:766-773. [PMID: 32181569 DOI: 10.1002/ccd.28858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We compared the effect of bivalirudin or heparin and use or nonuse of glycoprotein IIb/IIIa inhibitors (GPI) on the outcome of left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the randomized EXCEL trial. BACKGROUND The optimal antithrombotic regimen to support PCI of the LMCA remains controversial because of low representation of this subset in clinical trials. METHODS The PCI cohort (n = 928) in EXCEL was divided according to bivalirudin versus heparin antithrombin treatment and compared for the primary composite endpoint of death, myocardial infarction (MI), or stroke at 30 days and 5 years. RESULTS Bivalirudin was used in 319 patients (34.4%). The composite endpoint at 30 days occurred in 7.2% versus 3.8% bivalirudin and heparin patients, respectively, p = .02; at 5 years, the composite endpoint occurred in 26.3% versus 19.9% bivalirudin and heparin patients, respectively, p = .02. Major bleeding was more frequent in bivalirudin patients (4.1% versus 1.3%, p = .008). There were no differences in stent thrombosis between the groups. Bivalirudin use was an independent predictor of the 30-day composite endpoint (OR 2.88, 95% CI 1.28-6.48, p = .01) but not of the 5-year composite endpoint (OR 1.30, 95% CI 0.84-2.02, p = .23). GPI use was infrequent (n = 67, 7.2%) and was not associated with adverse outcomes. CONCLUSION Among patients undergoing LMCA PCI in the EXCEL trial, procedural use of bivalirudin was associated with greater rates of periprocedural MI and the 30-day composite endpoint without reducing bleeding complications. Five-year outcomes were similar. GPIs were used infrequently and were not associated with clinical outcomes.
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Affiliation(s)
- Sorin J Brener
- NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Nicholas J Lembo
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Manel Sabaté
- University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Paweł E Buszman
- Department of Epidemiology and Statistics, Medical School of Silesia, Katowice, Poland.,Department of Cardiovascular Research and Development, American Heart of Poland, Ustron, Poland
| | - Ioanna Kosmidou
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | | | - Ori Ben-Yehuda
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Samsky MD, Krucoff MW, Morrow DA, Abraham WT, Aguel F, Althouse AD, Chen E, Cigarroa JE, DeVore AD, Farb A, Gilchrist IC, Henry TD, Hochman JS, Kapur NK, Morrow V, Ohman EM, O'Neill WW, Piña IL, Proudfoot AG, Sapirstein JS, Seltzer JH, Senatore F, Shinnar M, Simonton CA, Tehrani BN, Thiele H, Truesdell AG, Waksman R, Rao SV. Cardiac safety research consortium "shock II" think tank report: Advancing practical approaches to generating evidence for the treatment of cardiogenic shock. Am Heart J 2020; 230:93-97. [PMID: 33011148 DOI: 10.1016/j.ahj.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
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Kandzari DE, Gershlick AH, Serruys PW, Leon MB, Morice MC, Simonton CA, Lembo NJ, Mansour S, Sabaté M, Sabik JF, Kappetein AP, Dressler O, Stone GW. Procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for left main trifurcation disease: the EXCEL trial. EUROINTERVENTION 2020; 16:e982-e988. [DOI: 10.4244/eij-d-19-00686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gregson J, Stone GW, Ben-Yehuda O, Redfors B, Kandzari DE, Morice MC, Leon MB, Kosmidou I, Lembo NJ, Brown WM, Karmpaliotis D, Banning AP, Pomar J, Sabaté M, Simonton CA, Dressler O, Kappetein AP, Sabik JF, Serruys PW, Pocock SJ. Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization. J Am Coll Cardiol 2020; 76:1609-1621. [DOI: 10.1016/j.jacc.2020.08.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
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Giustino G, Serruys PW, Sabik JF, Mehran R, Maehara A, Puskas JD, Simonton CA, Lembo NJ, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Ragosta M, Kron IL, Liu Y, Zhang Z, McAndrew T, Dressler O, Généreux P, Ben-Yehuda O, Pocock SJ, Kappetein AP, Stone GW. Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial. JACC Cardiovasc Interv 2020; 13:375-387. [PMID: 31954680 DOI: 10.1016/j.jcin.2019.09.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the incidence and impact on mortality of repeat revascularization after index percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). BACKGROUND The impact on mortality of the need of repeat revascularization following PCI or CABG in patients with unprotected LMCAD is unknown. METHODS All patients with LMCAD and site-assessed low or intermediate SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores randomized to PCI (n = 948) or CABG (n = 957) in the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial were included. Repeat revascularization events were adjudicated by an independent clinical events committee. The effect of repeat revascularization on mortality through 3-year follow-up was examined in time-varying Cox regression models. RESULTS During 3-year follow-up, there were 346 repeat revascularization procedures among 185 patients. PCI was associated with higher rates of any repeat revascularization (12.9% vs. 7.6%; hazard ratio: 1.73; 95% confidence interval: 1.28 to 2.33; p = 0.0003). Need for repeat revascularization was independently associated with increased risk for 3-year all-cause mortality (adjusted hazard ratio: 2.05; 95% confidence interval: 1.13 to 3.70; p = 0.02) and cardiovascular mortality (adjusted hazard ratio: 4.22; 95% confidence interval: 2.10 to 8.48; p < 0.0001) consistently after both PCI and CABG (pint = 0.85 for both endpoints). Although target vessel revascularization and target lesion revascularization were both associated with an increased risk for mortality, target vessel non-target lesion revascularization and non-target vessel revascularization were not. CONCLUSIONS In the EXCEL trial, repeat revascularization during follow-up was performed less frequently after CABG than PCI and was associated with increased mortality after both procedures. Reducing the need for repeat revascularization may further improve long-term survival after percutaneous or surgical treatment of LMCAD. (EXCEL Clinical Trial; NCT01205776).
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - John D Puskas
- Mount Sinai Heart at Mount Sinai St Luke's, New York, New York
| | | | - Nicholas J Lembo
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | | | | | - David P Taggart
- Department Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Michael Ragosta
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Irving L Kron
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
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Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J, Kandzari DE, Karmpaliotis D, Brown WM, Lembo NJ, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman PE, Bochenek A, Schampaert E, Pagé P, Modolo R, Gregson J, Simonton CA, Mehran R, Kosmidou I, Généreux P, Crowley A, Dressler O, Serruys PW. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med 2019; 381:1820-1830. [PMID: 31562798 DOI: 10.1056/nejmoa1909406] [Citation(s) in RCA: 455] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. METHODS We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. RESULTS At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9 to 6.5; P = 0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). CONCLUSIONS In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.).
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Affiliation(s)
- Gregg W Stone
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - A Pieter Kappetein
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Joseph F Sabik
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Stuart J Pocock
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Marie-Claude Morice
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - John Puskas
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - David E Kandzari
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Dimitri Karmpaliotis
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - W Morris Brown
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Nicholas J Lembo
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Adrian Banning
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Béla Merkely
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Ferenc Horkay
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Piet W Boonstra
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Ad J van Boven
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Imre Ungi
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Gabor Bogáts
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Samer Mansour
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Nicolas Noiseux
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Manel Sabaté
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Jose Pomar
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Mark Hickey
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Anthony Gershlick
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Pawel E Buszman
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Andrzej Bochenek
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Erick Schampaert
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Pierre Pagé
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Rodrigo Modolo
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - John Gregson
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Charles A Simonton
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Roxana Mehran
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Ioanna Kosmidou
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Philippe Généreux
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Aaron Crowley
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Ovidiu Dressler
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | - Patrick W Serruys
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York; Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands; University Hospitals Cleveland Medical Center, Cleveland (J.F.S.); the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.); Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.); Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal; Hospital Clinic, Barcelona (M.S., J. Pomar); Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek); University of Campinas, Campinas, Brazil (R. Modolo); Abbott Vascular, Santa Clara, CA (C.A.S.); and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
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8
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Kandzari DE, Gershlick AH, Serruys PW, Leon MB, Morice MC, Simonton CA, Lembo NJ, Banning AP, Merkely B, van Boven AJ, Ungi I, Kappetein AP, Sabik JF, Généreux P, Dressler O, Stone GW. Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 11:e007007. [PMID: 30354633 DOI: 10.1161/circinterventions.118.007007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distal left main (LM) coronary artery bifurcation disease increases percutaneous coronary intervention (PCI) procedural complexity and is associated with worse outcomes than isolated ostial/shaft disease. The optimal treatment strategy for distal LM disease is undetermined. We sought to determine whether outcomes after PCI of LM distal bifurcation lesions are influenced by treatment with a provisional 1-stent versus planned 2-stent technique, and if so, whether such differences are conditioned by the complexity of the LM bifurcation lesion. METHODS AND RESULTS The clinical and angiographic characteristics, procedural methods and outcomes, and clinical events through 3-year follow-up were compared in patients undergoing distal LM PCI with a 1-stent provisional versus planned 2-stent technique in the EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization). Among 529 patients undergoing planned distal LM PCI, 344 (65.0%) and 185 (35.0%) were treated with intended 1-stent provisional and planned 2-stent techniques, respectively. The primary composite end point rate of death, myocardial infarction, or stroke at 3 years was significantly lower in patients treated with the provisional 1-stent versus planned 2-stent method (14.1% versus 20.7%; adjusted hazard ratio, 0.55; 95% CI, 0.35-0.88; P=0.01), driven by differences in cardiovascular death (3.3% versus 8.3%, P=0.01) and myocardial infarction (7.7% versus 12.8%, P=0.06). The 3-year rate of ischemia-driven revascularization of the LM complex was also lower in the provisional group (7.2% versus 16.3%, P=0.001). In 342 patients with distal LM bifurcation disease that did not involve both major side branch vessels, the 3-year primary end point was lower with a provisional 1-stent versus planned 2-stent technique (13.8% versus 23.3%, P=0.04), whereas no significant difference was present in 182 patients with distal LM bifurcation disease that did involve both side branch vessels (14.3% versus 19.2%, P=0.36). CONCLUSIONS Among patients with distal LM bifurcation disease in the EXCEL trial randomized to PCI, 3-year adverse outcomes were worse with planned 2-stent treatment compared with a provisional 1-stent approach, a difference that was confined to patients without major involvement of both LM side branch vessels. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01205776.
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Affiliation(s)
| | - Anthony H Gershlick
- Leicester Biomedical Research Centre, University Hospitals of Leicester, University of Leicester, United Kingdom (A.H.G.)
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom (P.W.S.)
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | - Marie-Claude Morice
- Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France (M.-C.M.)
| | | | - Nicholas J Lembo
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | | | - Imre Ungi
- Cardiology Center, University of Szeged, Hungary (I.U.)
| | | | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, OH (J.F.S.)
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.).,Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.).,Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.)
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
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9
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Milojevic M, Serruys PW, Sabik JF, Kandzari DE, Schampaert E, van Boven AJ, Horkay F, Ungi I, Mansour S, Banning AP, Taggart DP, Sabaté M, Gershlick AH, Bochenek A, Pomar J, Lembo NJ, Noiseux N, Puskas JD, Crowley A, Kosmidou I, Mehran R, Ben-Yehuda O, Généreux P, Pocock SJ, Simonton CA, Stone GW, Kappetein AP. Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes. J Am Coll Cardiol 2019; 73:1616-1628. [DOI: 10.1016/j.jacc.2019.01.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
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10
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Ben-Yehuda O, Chen S, Redfors B, McAndrew T, Crowley A, Kosmidou I, Kandzari DE, Puskas JD, Morice MC, Taggart DP, Leon MB, Lembo NJ, Brown WM, Simonton CA, Dressler O, Kappetein AP, Sabik JF, Serruys PW, Stone GW. Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial. Eur Heart J 2019; 40:1930-1941. [DOI: 10.1093/eurheartj/ehz113] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/04/2018] [Accepted: 03/06/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Ioanna Kosmidou
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | | | - John D Puskas
- Mount Sinai Heart at Mount Sinai Saint Luke’s, New York, NY, USA
| | | | - David P Taggart
- Department Cardiac Surgery, John Radcliffe Hospital, Oxford, UK
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Nicholas J Lembo
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | | | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | | | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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11
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Giustino G, Mehran R, Serruys PW, Sabik JF, Milojevic M, Simonton CA, Puskas JD, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Généreux P, Zhang Z, McAndrew T, Redfors B, Ragosta M, Kron IL, Dressler O, Leon MB, Pocock SJ, Ben-Yehuda O, Kappetein AP, Stone GW. Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease. J Am Coll Cardiol 2018; 72:754-765. [DOI: 10.1016/j.jacc.2018.05.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 01/22/2023]
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12
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Baron SJ, Chinnakondepalli K, Magnuson EA, Kandzari DE, Puskas JD, Ben-Yehuda O, van Es GA, Taggart DP, Morice MC, Lembo NJ, Brown WM, Banning A, Simonton CA, Kappetein AP, Sabik JF, Serruys PW, Stone GW, Cohen DJ. Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for Left-Main Disease. J Am Coll Cardiol 2017; 70:3113-3122. [DOI: 10.1016/j.jacc.2017.10.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022]
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13
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Ali ZA, Gao R, Kimura T, Onuma Y, Kereiakes DJ, Ellis SG, Chevalier B, Vu MT, Zhang Z, Simonton CA, Serruys PW, Stone GW. Three-Year Outcomes With the Absorb Bioresorbable Scaffold: Individual-Patient-Data Meta-Analysis From the ABSORB Randomized Trials. Circulation 2017; 137:464-479. [PMID: 29089314 DOI: 10.1161/circulationaha.117.031843] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [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] [Received: 09/21/2017] [Accepted: 10/12/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Absorb bioresorbable vascular scaffold (BVS) completely resorbs within 3 years after coronary artery implantation. The safety and effectiveness of BVS through this critical 3-year period have not been characterized. METHODS We performed an individual-patient-data pooled meta-analysis of the 4 randomized ABSORB trials in which 3389 patients with coronary artery disease were randomly assigned to everolimus-eluting Absorb BVS (n=2164) or cobalt-chromium everolimus-eluting stents (n=1225). The primary efficacy outcome measure was target lesion failure (cardiac mortality, target vessel myocardial infarction, or ischemia-driven target lesion revascularization), and the primary safety outcome measure was device thrombosis. RESULTS BVS compared with cobalt-chromium everolimus-eluting stents resulted in higher 3-year rates of target lesion failure (11.7% versus 8.1%; risk ratio [RR], 1.38; 95% confidence interval [CI], 1.10-1.73; P=0.006), driven by greater target vessel myocardial infarction (7.8% versus 4.2%; RR, 1.72; 95% CI, 1.26-2.35; P=0.0006) and ischemia-driven target lesion revascularization (6.6% versus 4.4%; RR, 1.44; 95% CI, 1.05-1.98; P=0.02), with comparable cardiac mortality (1.1% versus 1.1%; RR, 0.93; 95% CI, 0.47-1.88; P=0.85). Device thrombosis rates through 3 years were also higher with BVS (2.4% versus 0.6%; RR, 3.71; 95% CI, 1.70-8.11; P=0.001). Between 1 and 3 years, target lesion failure rates (6.1% versus 3.9%; P=0.02) and device thrombosis rates (1.1% versus 0.0%; P<0.0001) were higher with BVS than cobalt-chromium everolimus-eluting stents. CONCLUSIONS In the present individual-patient-data pooled meta-analysis of the ABSORB trials, BVS was associated with increased rates of target lesion failure and device thrombosis between 1 and 3 years and cumulatively through 3 years of follow-up compared with everolimus-eluting stents. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifiers: NCT01751906, NCT01844284, NCT01923740, and NCT01425281.
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Affiliation(s)
- Ziad A Ali
- New York-Presbyterian Hospital/Columbia University Medical Center, New York (Z.A.A., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.A.A., G.W.S.)
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (R.G.)
| | | | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O.)
| | - Dean J Kereiakes
- The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, OH (D.J.K.)
| | | | | | - Minh-Thien Vu
- Abbott Vascular, Santa Clara, CA (M.-t.V., Z.Z., C.A.S.)
| | - Zhen Zhang
- Abbott Vascular, Santa Clara, CA (M.-t.V., Z.Z., C.A.S.)
| | | | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, UK (P.W.S.)
| | - Gregg W Stone
- New York-Presbyterian Hospital/Columbia University Medical Center, New York (Z.A.A., G.W.S.) .,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.A.A., G.W.S.)
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14
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Okuno T, Yahagi K, Horiuchi Y, Aoki J, Simonton CA, Rapoza R, Saito S, Kimura T, Tanabe K. Very Late Restenosis Following Bioresorbable Scaffold Implantation. JACC Cardiovasc Interv 2017; 10:e167-e169. [PMID: 28866033 DOI: 10.1016/j.jcin.2017.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Taishi Okuno
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | | | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
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Kappetein AP, Serruys PW, Sabik JF, Leon MB, Taggart DP, Morice MC, Gersh BJ, Pocock SJ, Cohen DJ, Wallentin L, Ben-Yehuda O, van Es GA, Simonton CA, Stone GW. Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial. EUROINTERVENTION 2017; 12:861-72. [PMID: 27639738 DOI: 10.4244/eijv12i7a141] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD. METHODS AND RESULTS The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a prospective, open-label, multicentre, international study of 1,900 randomised subjects. Patients with significant LMCAD with a SYNTAX score ≤32 and local Heart Team consensus that the subject is appropriate for revascularisation by both PCI and CABG are consented and randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo follow-up for five years. The primary endpoint is the three-year composite rate of death, stroke or myocardial infarction, assessed at a median follow-up of at least three years (with at least two-year follow-up in all patients), powered for sequential non-inferiority and superiority testing. CONCLUSIONS The EXCEL study will define the contemporary roles of CABG and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and intermediate SYNTAX scores.
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Affiliation(s)
- Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Stuckey TD, Kirtane AJ, Brodie BR, Witzenbichler B, Litherland C, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri EL, Gurbel PA, Mehran R, Généreux P, Ben-Yehuda O, Simonton CA, Stone GW. Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents: 2-Year Results of a Prospective, Multicenter Registry Study. JACC Cardiovasc Interv 2017; 10:1607-1617. [PMID: 28780034 DOI: 10.1016/j.jcin.2017.05.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In this analysis of 2-year outcomes in the ADAPT-DES (Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents) study, the authors sought to examine the independent associations between platelet reactivity to both aspirin and clopidogrel and subsequent outcomes. BACKGROUND The relationship between platelet reactivity and long-term adverse events following implantation of drug-eluting stents (DES) has been incompletely characterized. METHODS The ADAPT-DES study was a multicenter registry of patients undergoing routine platelet function testing following percutaneous coronary intervention with DES. The primary study endpoint was definite or probable stent thrombosis (ST); other endpoints were all-cause mortality, myocardial infarction, and clinically relevant bleeding. RESULTS A total of 8,582 patients were enrolled between 2008 and 2010; 46.3% of patients were on dual antiplatelet therapy at 2 years without discontinuation. At 2 years, definite or probable ST occurred in 92 patients (1.07%). In patients treated with dual antiplatelet therapy continuously for 2 years, high platelet reactivity on clopidogrel was independently associated with definite or probable ST (adjusted hazard ratio [HR]: 2.16; 95% confidence interval [CI]: 1.27 to 3.67; p = 0.003), myocardial infarction (adjusted HR: 1.35; 95% CI: 1.05 to 1.74; p = 0.02), freedom from clinically relevant bleeding (adjusted HR: 0.74; 95% CI: 0.62 to 0.90; p = 0.002), and all-cause mortality (adjusted HR: 1.36; 95% CI: 1.01 to 1.85; p = 0.04). Between years 1 and 2, high platelet reactivity was not associated with the very late ST and in patients on aspirin monotherapy, aspirin hyporesponsiveness was not associated with adverse outcomes. CONCLUSIONS The present study confirms the strong relationship of high platelet reactivity on clopidogrel to 2-year ischemic and bleeding outcomes after DES. The majority of stent-related events occurred within the first year.
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Affiliation(s)
- Thomas D Stuckey
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina.
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Bruce R Brodie
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina
| | | | - Claire Litherland
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Giora Weisz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Montefiore Medical Center, Bronx, New York
| | | | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, Heart Center University of Freiburg, Bad Krozingen, Germany
| | | | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California
| | - David A Cox
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, North Carolina
| | | | - Paul A Gurbel
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Roxana Mehran
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
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17
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Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, Kandzari DE, Morice MC, Lembo N, Brown WM, Taggart DP, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman P, Bochenek A, Schampaert E, Pagé P, Dressler O, Kosmidou I, Mehran R, Pocock SJ, Kappetein AP. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med 2016; 375:2223-2235. [PMID: 27797291 DOI: 10.1056/nejmoa1610227] [Citation(s) in RCA: 719] [Impact Index Per Article: 89.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P<0.001 for noninferiority, P=0.008 for superiority). The secondary end-point event of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years occurred in 23.1% of the patients in the PCI group and in 19.1% in the CABG group (P=0.01 for noninferiority, P=0.10 for superiority). CONCLUSIONS In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776 .).
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Affiliation(s)
- Gregg W Stone
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Joseph F Sabik
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Patrick W Serruys
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Charles A Simonton
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Philippe Généreux
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - John Puskas
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - David E Kandzari
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Marie-Claude Morice
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Nicholas Lembo
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - W Morris Brown
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - David P Taggart
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Adrian Banning
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Béla Merkely
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Ferenc Horkay
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Piet W Boonstra
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Ad J van Boven
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Imre Ungi
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Gabor Bogáts
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Samer Mansour
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Nicolas Noiseux
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Manel Sabaté
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - José Pomar
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Mark Hickey
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Anthony Gershlick
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Pawel Buszman
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Andrzej Bochenek
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Erick Schampaert
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Pierre Pagé
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Ovidiu Dressler
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Ioanna Kosmidou
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Roxana Mehran
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - Stuart J Pocock
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
| | - A Pieter Kappetein
- From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York; the Cleveland Clinic Foundation, Cleveland (J.F.S.); the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom; Abbott Vascular, Santa Clara, CA (C.A.S.); Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal; Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.); Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.); Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary; Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands; Hospital Clinic, Barcelona (M.S., J. Pomar); and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek)
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Généreux P, Rutledge DR, Palmerini T, Caixeta A, Kedhi E, Hermiller JB, Wang J, Krucoff MW, Jones-McMeans J, Sudhir K, Simonton CA, Serruys PW, Stone GW. Stent Thrombosis and Dual Antiplatelet Therapy Interruption With Everolimus-Eluting Stents: Insights From the Xience V Coronary Stent System Trials. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.001362. [PMID: 25940520 DOI: 10.1161/circinterventions.114.001362] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. METHODS AND RESULTS Outcomes from 11,219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95% confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95% confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). CONCLUSIONS In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180310, NCT00180479, NCT00307047, NCT00402272, NCT00496938, NCT00676520, and NCT00631228.
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Affiliation(s)
- Philippe Généreux
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - David R Rutledge
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Tullio Palmerini
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Adriano Caixeta
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Elvin Kedhi
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - James B Hermiller
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Jin Wang
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Mitchell W Krucoff
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Jennifer Jones-McMeans
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Krishnankutty Sudhir
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Charles A Simonton
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Patrick W Serruys
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Gregg W Stone
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.).
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Campos CM, van Klaveren D, Farooq V, Simonton CA, Kappetein AP, Sabik JF, Steyerberg EW, Stone GW, Serruys PW. Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II. Eur Heart J 2015; 36:1231-41. [PMID: 25583761 DOI: 10.1093/eurheartj/ehu518] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/22/2014] [Indexed: 12/15/2022] Open
Abstract
AIMS To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. METHODS AND RESULTS Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). CONCLUSION The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
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Affiliation(s)
- Carlos M Campos
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, The Netherlands Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - David van Klaveren
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, The Netherlands
| | - Vasim Farooq
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK
| | | | - Arie-Pieter Kappetein
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, The Netherlands
| | - Joseph F Sabik
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Ewout W Steyerberg
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, The Netherlands
| | - Gregg W Stone
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Patrick W Serruys
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, The Netherlands International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
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Shiomi H, Kozuma K, Morimoto T, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Abe M, Suwa S, Muramatsu T, Kobayashi M, Dai K, Nakao K, Uematsu M, Tarutani Y, Fujii K, Simonton CA, Kimura T. Long-Term Clinical Outcomes After Everolimus- and Sirolimus-Eluting Coronary Stent Implantation. Circ Cardiovasc Interv 2014; 7:343-54. [DOI: 10.1161/circinterventions.113.001322] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 11/16/2022]
Affiliation(s)
- Hiroki Shiomi
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Ken Kozuma
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Takeshi Morimoto
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Keiichi Igarashi
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Kazushige Kadota
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Kengo Tanabe
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Yoshihiro Morino
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Mitsuru Abe
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Satoru Suwa
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Toshiya Muramatsu
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Masakazu Kobayashi
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Kazuoki Dai
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Koichi Nakao
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Masaaki Uematsu
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Yasuhiro Tarutani
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Kenshi Fujii
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Charles A. Simonton
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
| | - Takeshi Kimura
- From the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.K.); Department of Cardiology, Teikyo University Hospital, Tokyo, Japan (K. Kozuma); Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T. Morimoto); Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan (K.I.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K. Kadota); Department
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Brener SJ, Kereiakes DJ, Simonton CA, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, Smith RS, Ying SW, Cutlip DE, Stone GW. Everolimus-eluting stents in patients undergoing percutaneous coronary intervention: final 3-year results of the Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With de Novo Native Coronary Artery Lesions trial. Am Heart J 2013; 166:1035-42. [PMID: 24268218 DOI: 10.1016/j.ahj.2013.08.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We compared the outcomes of patients treated with everolimus-eluting stents (EES) versus paclitaxel-eluting stents (PES) at 3 years from the large-scale randomized SPIRIT IV trial. BACKGROUND SPIRIT IV is the largest randomized trial comparing the outcomes of EES and PES. The present report represents the final long-term follow-up analysis from this study. METHODS A total of 3,687 patients were randomized 2:1 to EES or PES, stratified by presence of diabetes mellitus and lesion characteristics. Prespecified subgroups were compared for interaction with stent allocation. The primary end point was target lesion failure (TLF) (the composite of cardiac death, target vessel-related myocardial infarction [MI], or ischemia-driven target lesion revascularization). RESULTS At 3 years, TLF occurred in 9.2% versus 11.7% of EES- and PES-treated patients (hazard ratio [HR] 0.78 [0.63-0.97], P = .02). The incidence of death or MI was 5.9% versus 9.1%, respectively (HR 0.67 [0.52-0.85], P = .001), and there was a 64% reduction in stent thrombosis (Academic Research Consortium definite or probable definition) with EES (0.59% vs 1.60%, HR 0.36 [0.18-0.72], P = .003). The difference in target lesion revascularization at 3 years did not reach statistical significance (6.2% vs 7.8%, respectively, HR 0.78 [0.60-1.01], P = .06). There was no significant interaction between treatment allocation and any of the subgroups, including diabetes. CONCLUSIONS When compared with PES, EES provides durable and significant reduction in TLF, especially due to its enhanced safety profile, with lower rates of death or MI and stent thrombosis up to 3 years.
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Yazdani SK, Sheehy A, Nakano M, Nakazawa G, Vorpahl M, Otsuka F, Donn RS, Perkins LE, Simonton CA, Kolodgie FD, Virmani R. Preclinical evaluation of second-generation everolimus- and zotarolimus-eluting coronary stents. J Invasive Cardiol 2013; 25:383-390. [PMID: 23913602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study was designed to evaluate the pharmacokinetic and vascular healing of a second-generation everolimus-eluting stent (EES) and slow-release zotarolimus-eluting stent (R-ZES). BACKGROUND Second-generation DESs have alleviated the safety concerns of late stent thrombosis by addressing issues of polymer biocompatibility and stent design, and optimizing drug loads and release kinetics. No preclinical comparison study exists between these stents. METHODS Rabbit iliac artery stent implantation was performed using Xience Prime EES and Resolute R-ZES. Histomorphometric evaluation was performed at 28 and 60 days after implantation in an induced atheroma model. Endothelial coverage and maturation were assessed by scanning electron microscopy and immuno-labeling at 14 and 28 days following deployment. For pharmacokinetic studies, arterial tissue and stents were retrieved at 3, 14, 28, and 90 days, and blood samples were obtained during the first 24 hours. RESULTS Vascular remodeling (percent stenosis, neointimal thickness) was similar in arteries implanted with either stent group. At 28 days, inflammation was significantly less in the EES group as compared to the R-ZES group (inflammation score: 1.59 ± 0.52 vs 2.22 ± 0.69, respectively; P=.044), with no differences observed at 60 days. Endothelial coverage was similar between both groups; however, endothelial maturation above stent struts was significantly higher in the EES group vs R-ZES group at 28 days (33 ± 20% vs 22 ± 21%, respectively; P=.040). Arterial drug level concentrations were also shown to be significantly less in the EES group vs the R-ZES group (P<.0001). CONCLUSIONS Overall, EES and R-ZES displayed similar remodeling properties with lower arterial drug levels observed in the EES group vs the R-ZES group, which may have led to more rapid endothelial maturation.
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Stilp E, Baird C, Gray WA, Schneider PA, Simonton CA, Verta P, Mena-Hurtado CI. An evidence-based review of the impact of periprocedural myocardial infarction in carotid revascularization. Catheter Cardiovasc Interv 2013; 82:709-14. [PMID: 23765902 DOI: 10.1002/ccd.25056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/13/2013] [Accepted: 06/01/2013] [Indexed: 11/06/2022]
Abstract
Landmark trials comparing carotid endarterectomy (CEA) with medical therapy in patients with symptomatic or asymptomatic atherosclerotic stenosis of extracranial carotid arteries have favored carotid revascularization. Carotid artery stenting (CAS) has emerged as a minimally invasive option for revascularization of carotid artery stenoses and has been shown to be noninferior to CEA, regardless of patient symptom status. Debate continues regarding the importance of periprocedural myocardial infarction (PMI) as an endpoint in carotid revascularization trials. Recent randomized comparisons of CEA and CAS pre-specify PMI as an endpoint. Understanding PMI in CEA and CAS, the need for routine biomarker assessment surrounding both revascularization strategies, the effect of PMI on long-term morbidity and mortality, and the groups most at risk for PMI are of critical importance when choosing a carotid revascularization strategy for symptomatic and asymptomatic patients, since decreasing the incidence of PMI will make revascularization safer. This review examines available data regarding the relevance of PMI in vascular and carotid-specific outcomes.
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Affiliation(s)
- Erik Stilp
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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Sudhir K, Hermiller JB, Naidu SS, Henry TD, Mao VW, Zhao W, Ferguson JM, Wang J, Jonnavithula L, Simonton CA, Rutledge DR, Krucoff MW. Clinical outcomes in real-world patients with acute myocardial infarction receiving XIENCE V® everolimus-eluting stents: one-year results from the XIENCE V USA study. Catheter Cardiovasc Interv 2013; 82:E385-94. [PMID: 23172848 DOI: 10.1002/ccd.24749] [Citation(s) in RCA: 4] [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] [Received: 05/22/2012] [Accepted: 11/07/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The objective of this analysis was to evaluate the safety and effectiveness of XIENCE V in acute myocardial infarction (AMI). BACKGROUND The XIENCE V(®) Everolimus-eluting coronary stent was superior to the TAXUS(®) paclitaxel-eluting stent in angiographic and clinical outcomes in the SPIRIT II, III, and IV randomized controlled trials, but patients with AMI were excluded. METHODS XIENCE V USA is a large, prospective, multicenter, real-world single-arm postmarket surveillance trial. Consecutive patients undergoing PCI with XIENCE V were enrolled. For this analysis, clinical outcomes in 673 patients presenting with AMI (STEMI, n = 125) were as compared to patients without AMI (n = 3528) at 1 year. RESULTS At 1 year, ARC-defined stent thrombosis (ST) rates were 1.08% in AMI vs. 0.85% in the non-AMI group (P = 0.4987). The late ST (30 days-1 year) rates were 0.31% vs. 0.47% (AMI vs. non-AMI, P = 0.7551). Rates of target lesion revascularization (TLR) were 4.1% vs. 4.6% (P = 0.6104), and rates of target lesion failure (TLF) were 9.1% vs. 8.5%, (P = 0.5964). With the historical WHO definition of MI, 1 year TLF rates were 7.0% vs. 6.7% (P = 0.8001). Improvements in quality of life, angina frequency, angina stability, and physical limitations occurred at 6 months (each P < 0.0001) and were sustained at 1 year in both groups. There were no significant differences in clinical outcomes between STEMI and non-STEMI patients. CONCLUSIONS At 1 year, AMI patients treated with XIENCE V had low rates of ST, TLR, and TLF, similar to non-AMI patients. Marked improvements in patients' health status in this subgroup were also demonstrated.
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Affiliation(s)
- Krishnankutty Sudhir
- Center for Cardiovascular Technology, Stanford University, Palo Alto, California; Abbott Vascular, Santa Clara, California
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Bosiers M, Scheinert D, Simonton CA, Schwartz LB. Coronary and endovascular applications of the Absorb™ bioresorbable vascular scaffold. Interv Cardiol 2012. [DOI: 10.2217/ica.12.62] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Amin AP, Reynolds MR, Lei Y, Magnuson EA, Vilain K, Durtschi AJ, Simonton CA, Stone GW, Cohen DJ. Cost-effectiveness of everolimus- versus paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization (from the SPIRIT-IV Trial). Am J Cardiol 2012; 110:765-70. [PMID: 22651880 DOI: 10.1016/j.amjcard.2012.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
Although several drug-eluting stents (DESs) have been shown to be economically attractive compared to bare-metal stents in patients at moderate to high risk of restenosis, little is known about the cost-effectiveness of alternative DES designs, especially second-generation DESs. We therefore performed an economic substudy alongside the SPIRIT-IV trial, in which 3,687 patients undergoing single or multivessel percutaneous coronary intervention were randomized to receive second-generation everolimus-eluting stents (EESs; n = 2,458) or first-generation paclitaxel-eluting stents (PESs; n = 1,229). Costs through 2 years of follow-up were assessed from the perspective of the United States health care system. The primary cost-effectiveness end point was the incremental cost-effectiveness ratio assessed as cost per quality-adjusted life year gained. Over a 2-year period, use of EESs versus PESs led to a trend toward decreased overall repeat revascularization procedures (14.2 vs 16.2 per 100 subjects, p = 0.20) driven by a significant decrease in the number of target vessel revascularization procedures (8.2 vs 11.0 per 100 subjects, p = 0.02) but also a slight increase in the number of nontarget vessel revascularization procedures (6.0 vs 5.1 per 100 subjects, p = 0.37). Follow-up cardiovascular costs were decreased by $273/patient in the EES group (95% confidence interval for difference 1,048 less to 502 more, p = 0.49). Formal cost-effectiveness analysis based on these results demonstrated that the probability that EES was an economically attractive strategy (incremental cost-effectiveness ratio <$50,000/quality-adjusted life year gained) was 85.7%. These findings demonstrate that in patients undergoing percutaneous coronary intervention with DESs, use of EESs is economically attractive compared to PESs with improved clinical outcomes and lower overall medical care costs at 2 years.
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Kimura T, Morimoto T, Natsuaki M, Shiomi H, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Takatsu Y, Nishikawa H, Yamamoto Y, Nakagawa Y, Hayashi Y, Iwabuchi M, Umeda H, Kawai K, Okada H, Kimura K, Simonton CA, Kozuma K. Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the Randomized Evaluation of Sirolimus-eluting Versus Everolimus-eluting stent Trial (RESET). Circulation 2012; 126:1225-36. [PMID: 22824435 DOI: 10.1161/circulationaha.112.104059] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [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: 01/27/2023]
Abstract
BACKGROUND Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes. However, only 1 trial was powered for a clinical end point, and no trial was powered for evaluating target-lesion revascularization. METHODS AND RESULTS Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. The trial was powered for evaluating noninferiority of EES relative to SES in terms of target-lesion revascularization. From February and July 2010, 3197 patients were randomly assigned to receive either EES (1597 patients) or SES (1600 patients). At 1 year, the primary efficacy end point of target-lesion revascularization occurred in 65 patients (4.3%) in the EES group and in 76 patients (5.0%) in the SES group, demonstrating noninferiority of EES to SES (P(noninferiority)<0.0001, and P(superiority)=0.34). Cumulative incidence of definite stent thrombosis was low and similar between the 2 groups (0.32% versus 0.38%, P=0.77). An angiographic substudy enrolling 571 patients (EES, 285 patients and SES, 286 patients) demonstrated noninferiority of EES relative to SES regarding the primary angiographic end point of in-segment late loss (0.06±0.37 mm versus 0.02±0.46 mm, P(noninferiority)<0.0001, and P(superiority)=0.24) at 278±63 days after index stent implantation. CONCLUSIONS One-year clinical and angiographic outcome after EES implantation was noninferior to and not different from that after SES implantation in a stable coronary artery disease population with relatively less complex coronary anatomy. One-year clinical outcome after both EES and SES use was excellent with a low rate of target-lesion revascularization and a very low rate of stent thrombosis. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035450.
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Affiliation(s)
- Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Kyoto, Japan 606-8507.
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Claessen BE, Smits PC, Kereiakes DJ, Parise H, Fahy M, Kedhi E, Serruys PW, Lansky AJ, Cristea E, Sudhir K, Sood P, Simonton CA, Stone GW. Impact of lesion length and vessel size on clinical outcomes after percutaneous coronary intervention with everolimus- versus paclitaxel-eluting stents pooled analysis from the SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) and COMPARE (Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) Randomized Trials. JACC Cardiovasc Interv 2012; 4:1209-15. [PMID: 22115661 DOI: 10.1016/j.jcin.2011.07.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of reference vessel diameter (RVD) and lesion length (LL) on the relative safety and efficacy of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES). BACKGROUND Lesion length and RVD are well-known predictors of adverse events after percutaneous coronary intervention. METHODS Patient-level data were pooled from the randomized SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) II, III, IV and COMPARE (Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) trials. Quantitative angiographic core laboratory data were available for 6,183 patients randomized to EES (n = 3,944) or PES (n = 2,239). Long lesions and small vessels were defined as LL >median (13.4 mm) and RVD ≤median (2.65 mm), respectively. Major adverse cardiac events (MACE) (consisting of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed at 2 years, according to stent type in 3 groups: short lesions in large vessels (group A, n = 1,297); long lesions or small vessels but not both (group B, n = 2,981); and long lesions in small vessels (group C, n = 1,905). RESULTS The pooled 2-year MACE rates were 5.6%, 8.2%, and 10.4% in Groups A, B, and C, respectively (p < 0.0001). There was no significant interaction between lesion group and stent type (p = 0.64), indicating lower MACE with EES compared with PES regardless of LL and RVD. However, the absolute difference was largest in Groups B and C. In Group A, 2-year MACE rates were not significantly different between EES and PES (4.8% vs. 7.0%, respectively, p = 0.11). In contrast, EES was associated with lower 2-year rates of MACE in Group B (6.6% vs. 11.2%, p < 0.01) and in Group C (9.1% vs. 12.7%, p = 0.008) as well as lower rates of myocardial infarction, target lesion revascularization, and stent thrombosis. Multivariable analysis confirmed EES versus PES as an independent predictor of freedom from MACE in Groups B and C. CONCLUSIONS Patients with short lesions in large vessels have low rates of MACE at 2 years after treatment with either EES or PES. In higher-risk patients with long lesions and/or small vessels, EES results in significant improvements in both clinical safety and efficacy outcomes. (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions; NCT00180310; SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00180479; SPIRIT IV Clinical Trial: Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00307047; A Randomized Controlled Trial of Everolimus-eluting Stents and Paclitaxel-eluting Stents for Coronary Revascularization in Daily Practice: The COMPARE Trial; NCT01016041).
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Affiliation(s)
- Bimmer E Claessen
- New York Presbyterian Hospital, Columbia University, New York, NY, USA
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Krucoff MW, Rutledge DR, Gruberg L, Jonnavithula L, Katopodis JN, Lombardi W, Mao VW, Sharma SK, Simonton CA, Tamboli HP, Wang J, Wilburn O, Zhao W, Sudhir K, Hermiller JB. A New Era of Prospective Real-World Safety Evaluation. JACC Cardiovasc Interv 2011; 4:1298-309. [DOI: 10.1016/j.jcin.2011.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/26/2011] [Accepted: 08/04/2011] [Indexed: 02/01/2023]
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Kereiakes DJ, Cutlip DE, Applegate RJ, Wang J, Yaqub M, Sood P, Su X, Su G, Farhat N, Rizvi A, Simonton CA, Sudhir K, Stone GW. Outcomes in Diabetic and Nondiabetic Patients Treated With Everolimus- or Paclitaxel-Eluting Stents. J Am Coll Cardiol 2010; 56:2084-9. [DOI: 10.1016/j.jacc.2010.10.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/30/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
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Lansky AJ, Wang J, Kereiakes D, Sood P, Yaqub M, Shih-Wa Y, Simonton CA, Caputo R, Applegate R, Stone GW. One-year outcomes of everolimus-eluting and paclitaxel-eluting coronary stents in women: analysis from the Spirit IV Trial. Cardiovascular Revascularization Medicine 2010. [DOI: 10.1016/j.carrev.2010.03.029] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kandzari DE, Rao SV, Moses JW, Dzavik V, Strauss BH, Kutryk MJ, Simonton CA, Garg J, Lokhnygina Y, Mancini GBJ, Yeoh E, Buller CE. Clinical and angiographic outcomes with sirolimus-eluting stents in total coronary occlusions: the ACROSS/TOSCA-4 (Approaches to Chronic Occlusions With Sirolimus-Eluting Stents/Total Occlusion Study of Coronary Arteries-4) trial. JACC Cardiovasc Interv 2010; 2:97-106. [PMID: 19463409 DOI: 10.1016/j.jcin.2008.10.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 09/30/2008] [Accepted: 10/10/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to examine angiographic and clinical outcomes with sirolimus-eluting stents (SES) in total coronary occlusion (TCO) revascularization. BACKGROUND Despite evaluation of drug-eluting stents beyond approved indications, few studies have evaluated their clinical benefit in TCO revascularization. METHODS Among 15 centers in North America, 200 consecutive TCO patients (78.8% >6 weeks TCO age) were enrolled for treatment with SES. The primary end point was 6-month angiographic binary restenosis within the treated segment. RESULTS Patient characteristics included: diabetes, 24.5%; prior infarction, 33.5%; and stent length, 45.9 mm median (quartile 1, 30.2 mm; quartile 2, 62.1 mm). A total of 199 patients (99.5%) were treated with SES, and procedural success was 98.0%. The 6-month binary restenosis rates were 9.5% in-stent, 12.4% in-segment, and 22.6% in-"working length" representing the entire treatment segment. Rates of 1-year target lesion revascularization, myocardial infarction, and target vessel failure were 9.8%, 1.0%, and 10.9%, respectively. Stent thrombosis occurred in 2 patients (1.0%). Using logistic regression modeling with propensity score adjustment, the absolute reduction in binary restenosis with SES compared with a historical bare-metal stent control was 37.7% (95% confidence interval [CI]: 27.2% to 48.3%, p < 0.001; odds ratio: 0.17, 95% CI: 0.09 to 0.30, p < 0.0001). Among 32 patients (16%) identified with stent fracture, target lesion revascularization was more common than patients without fracture (25.0% vs. 6.7%, p = 0.005). CONCLUSIONS Despite greater lesion complexity than prior TCO trials, percutaneous revascularization with SES appears safe and results in substantial reductions in angiographic restenosis and failed patency and a low rate of repeat revascularization. These findings support the use of SES in TCO revascularization. (The ACROSS/TOSCA Trial; NCT00378612).
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Affiliation(s)
- David E Kandzari
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA.
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Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, Doostzadeh J, Cao S, Simonton CA, Sudhir K, Lansky AJ, Cutlip DE, Kereiakes DJ. Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. N Engl J Med 2010; 362:1663-74. [PMID: 20445180 DOI: 10.1056/nejmoa0910496] [Citation(s) in RCA: 670] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have established the superiority of coronary everolimus-eluting stents over paclitaxel-eluting stents with respect to angiographic findings. However, these trials were not powered for superiority in clinical end points. METHODS We randomly assigned 3687 patients at 66 U.S. sites to receive everolimus-eluting stents or paclitaxel-eluting stents without routine follow-up angiography. The primary end point was the 1-year composite rate of target-lesion failure (defined as cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization). RESULTS Everolimus-eluting stents were superior to paclitaxel-eluting stents with respect to the primary end point of target-lesion failure (4.2% vs. 6.8%; relative risk, 0.62; 95% confidence interval, 0.46 to 0.82; P=0.001). Everolimus-eluting stents were also superior with respect to the major secondary end point of the 1-year rate of ischemia-driven target-lesion revascularization (P=0.001) and were noninferior with respect to the major secondary end point of the 1-year composite rate of cardiac death or target-vessel myocardial infarction (P<0.001 for noninferiority; P=0.09 for superiority). The 1-year rates of myocardial infarction and stent thrombosis were also lower with everolimus-eluting stents than with paclitaxel-eluting stents (1.9% vs. 3.1%, P=0.02 for myocardial infarction; 0.17% vs. 0.85%, P=0.004 for stent thrombosis). Target-lesion failure was consistently reduced with everolimus-eluting stents as compared with paclitaxel-eluting stents in 12 prespecified subgroups, except in the subgroup of patients with diabetes (6.4% vs. 6.9%, P=0.80). CONCLUSIONS Everolimus-eluting stents, as compared with paclitaxel-eluting stents, resulted in reduced rates of target-lesion failure at 1 year, results that were consistent in all patients except those with diabetes, in whom the results were nonsignificantly different. (ClinicalTrials.gov number, NCT00307047.)
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Affiliation(s)
- Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA.
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Applegate RJ, Sudhir K, Hermiller JB, Doostzadeh J, Yu S, Hattori K, Lansky AJ, Cutlip DE, Simonton CA, Stone GW. LONG-TERM SAFETY PROFILE OF XIENCE V EVEROLIMUS-ELUTING COMPARED TO TAXUS EXPRESS PACLITAXEL-ELUTING STENTS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cox DA, Sudhir K, Hermiller JB, Applegate RJ, Gordon PC, Doostzadeh J, Jonnavithula LK, Koo K, Maloney TH, Lansky AJ, Simonton CA, Stone GW. EVALUATION OF THIENOPYRIDINE COMPLIANCE AND STENT THROMBOSIS RATES AFTER EVEROLIMUS-ELUTING AND PACLITAXEL-ELUTING STENT IMPLANTATION: 3-YEAR RESULTS FROM THE SPIRIT III ANALYSIS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61792-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brodie BR, Wilson H, Stuckey T, Nussbaum M, Laurent S, Bradshaw B, Humphrey A, Metzger C, Hermiller J, Krainin F, Juk S, Cheek B, Duffy P, Simonton CA. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv 2010; 2:1105-12. [PMID: 19926052 DOI: 10.1016/j.jcin.2009.08.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/24/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compares outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients undergoing saphenous vein graft (SVG) intervention. BACKGROUND The safety and efficacy of DES in patients undergoing SVG intervention is controversial. METHODS The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is a multicenter U.S. registry evaluating outcomes with DES. Our study population includes patients undergoing PCI of SVG lesions with DES (n = 785) or BMS (n = 343) who completed 9-month or 2-year follow-up. Outcomes were adjusted with propensity analyses. RESULTS The DES patients had fewer emergent procedures but had smaller vessels and longer lesions. The DES patients had less death or myocardial infarction at 9 months (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.33 to 0.83, p = 0.006) and less death at 2 years (HR: 0.60, 95% CI: 0.36 to 0.98, p = 0.041). Target vessel revascularization (TVR) was less with DES at 9 months (7.2% vs. 10.0%, HR: 0.36, 95% CI: 0.22 to 0.61, p < 0.001) but was no different by 2 years (18.3% vs. 16.9%, p = 0.86), although adjusted TVR rates were lower (HR: 0.60, 95% CI: 0.40 to 0.90, p = 0.014). The DES reduced TVR at 9 months in SVG lesions with diameter <3.5 mm (8.0% vs. 17.2%, p = 0.013) but not >or=3.5 mm (6.0% vs. 6.6%, p = 0.74). CONCLUSIONS Treatment of SVG lesions with DES vs. BMS is effective in reducing TVR at 9 months, although most of this advantage is lost at 2 years. The DES seem safe with less death or myocardial infarction, although selection bias might have affected these results. Our data suggest that DES might have short-term advantages over BMS in SVG lesions with diameter <3.5 mm.
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Affiliation(s)
- Bruce R Brodie
- The LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina 27408, USA.
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Brodie BR, Stuckey T, Downey W, Humphrey A, Bradshaw B, Metzger C, Hermiller J, Krainin F, Juk S, Cheek B, Duffy P, Smith H, Edmunds J, Varanasi J, Simonton CA. Outcomes and complications with off-label use of drug-eluting stents: results from the STENT (Strategic Transcatheter Evaluation of New Therapies) group. JACC Cardiovasc Interv 2009; 1:405-14. [PMID: 19463338 DOI: 10.1016/j.jcin.2008.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/22/2008] [Accepted: 06/12/2008] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study evaluates outcomes and complications in patients treated with drug-eluting stents (DES) for "off-label" indications. BACKGROUND Drug-eluting stents have been effective in randomized trials, but their safety and efficacy for off-label indications has not been well studied. METHODS The STENT (Strategic Transcatheter Evaluation of New Therapies) Registry is the largest multicenter U.S. registry evaluating outcomes of DES. Off-label indications included ostial, left main, long, bifurcation, and in-stent restenotic lesions, saphenous vein grafts, chronic total occlusions, small or large vessels, multilesion or multivessel percutaneous coronary interventions, and ST-segment elevation myocardial infarction. Outcomes were adjusted using Cox proportional hazards regression and propensity analyses. RESULTS Drug-eluting stents were used in an off-label manner in 59% of patients. The patients who received off-label treatment were more often male, had a higher incidence of prior infarction and bypass surgery, and lower ejection fractions. Off-label versus "on-label" use of DES was associated with higher rates of death, myocardial infarction, target vessel revascularization, major adverse cardiac events, and stent thrombosis at 9 months and 2 years. Off-label use of DES compared with off-label use of bare-metal stents (BMS) had lower rates of death, myocardial infarction, target vessel revascularization, and major adverse cardiac events at 9 months and 2 years and lower rates of stent thrombosis at 9 months. CONCLUSIONS Off-label use of DES is associated with higher event rates compared with on-label use of DES, which is consistent with a higher risk clinical and lesion profile. However, event rates with off-label use of DES are lower compared with off-label use of BMS. Pending results from randomized trials, our data support the use of DES for off-label indications in selected patients.
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Affiliation(s)
- Bruce R Brodie
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, USA.
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Brodie BR, Stuckey T, Downey W, Humphrey A, Nussbaum M, Laurent S, Bradshaw B, Metzger C, Hermiller J, Krainin F, Juk S, Cheek B, Duffy P, Simonton CA. Outcomes with drug-eluting stents versus bare metal stents in acute ST-elevation myocardial infarction: Results from the Strategic Transcatheter Evaluation of New Therapies (STENT) Group. Catheter Cardiovasc Interv 2008; 72:893-900. [DOI: 10.1002/ccd.21767] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Simonton CA, Brodie B, Cheek B, Krainin F, Metzger C, Hermiller J, Juk S, Duffy P, Humphrey A, Nussbaum M, Laurent S. Comparative clinical outcomes of paclitaxel- and sirolimus-eluting stents: results from a large prospective multicenter registry--STENT Group. J Am Coll Cardiol 2007; 50:1214-22. [PMID: 17888837 DOI: 10.1016/j.jacc.2007.06.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 05/29/2007] [Accepted: 06/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the 9-month clinical outcomes of patients treated with paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES) for coronary artery stenosis. BACKGROUND The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is the first multicenter registry in the U.S. to collect long-term outcomes of drug-eluting stents from "real-world" practice. METHODS Data on all percutaneous coronary interventions in 8 U.S. hospital centers were collected in the STENT registry between 2003 and 2005. In this prospective, nonrandomized, observational study, the choice of procedures was at the physicians' discretion. Patients who only received a PES (n = 4,671) or SES (n = 4,555) and completed 9-month follow-up (93.8% of eligible) were included for analysis. Primary end points were death, myocardial infarction (MI), and target vessel revascularization (TVR) at 9 months. Secondary outcomes included major adverse cardiac events (MACE) (any of the 3 primary end points) and stent thrombosis. RESULTS At 9 months, death, MI, and TVR occurred in 2.2%, 2.0%, and 4.1%, respectively, of the PES group and 2.5%, 2.2%, and 4.3%, respectively, of the SES group (p = NS); MACE occurred in 7.5% of the PES group and 8.0% of the SES group (p = 0.37). After adjustments for group differences in baseline characteristics, TVR (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.70 to 1.32; p = 0.26) and MACE (HR 0.95, 95% CI 0.81 to 1.12; p = 0.56) were similar for PES and SES. Stent thrombosis at 9 months occurred in 0.7% of both groups. CONCLUSIONS The results of this study show that clinical restenosis and MACE events after PES and SES procedures in "real-world" patients are infrequent and similar at 9 months.
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Affiliation(s)
- Charles A Simonton
- Carolinas Heart Institute, Carolinas Medical Center, Charlotte, North Carolina, USA.
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Simonton CA, Brodie BR, Wilson H, Haber R, Kowalchuk G, Rinaldi M, Cedarholm J, Humphrey A, Laurent S. AngioJet experience from the multi-center STENT Registry. J Invasive Cardiol 2006; 18 Suppl C:C22-3. [PMID: 16883028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To explore the utilization and clinical outcomes of AngioJet Rheolytic thrombectomy from the Strategic Transcatheter Evaluation of New Therapies (STENT) multi-center prospective registry from May 2003 through December 2005. METHODS Prospective consent was sought for all consecutive percutaneous coronary intervention (PCI) patients at all institutions and achieved in 84% of all patients. Of these, clinical follow-up at 9 months was achieved in 94% of eligible patients at all institutions. RESULTS Of a total of 9,707 patients, AngioJet was utilized in 3-4% of all procedures, including 12-14% of all procedures with thrombolysis in myocardial infarction (TIMI) grade 3 thrombus or greater and 10-12% of acute evolving MI patients. Nine-month clinical outcomes showed similar mortality rates for patients treated with AngioJet (5.0%) versus those with no thrombectomy (6.5%) for patients with thrombus grade 3 or greater, despite the higher clinical risk profile of the AngioJet patient population due to a higher percentage of cardiogenic shock and larger thrombus. CONCLUSION The results of this larger, multi-center registry indicate that AngioJet thrombectomy, when selected in general clinical practice for high risk patients with thrombus, results in non-significant numerically lower rate of mortality with no indication of safety issues.
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Affiliation(s)
- Charles A Simonton
- Sanger Clinic, Carolinas Heart Institute, Charlotte, North Carolina 28203, USA.
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Simonton CA, Brodie BR, Wilson BH. Drug-eluting stents for emerging treatment strategies in complex lesions. Rev Cardiovasc Med 2005; 6 Suppl 1:S38-47. [PMID: 15665797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The use of drug-eluting stents (DES) has rapidly expanded from lower-risk, single-lesion procedures to include a broad spectrum of high-risk patients and complex lesions. For 4 complex patient subgroups, emerging data suggest that DES might offer an advantage for reducing late clinical restenosis. In ST elevation myocardial infarction, early registry reports are promising, with no evidence to date for an increased incidence of subacute stent thrombosis and significant trends for less restenosis. For chronic total occlusions, early, small clinical series show that DES might have unprecedented long-term patency. Initial registries of DES for in-stent restenosis reveal striking reductions in late loss and restenosis, compared with brachytherapy historical controls. The use of DES in saphenous vein graft lesions is increasing, and early registry results show a very acceptable incidence of thromboembolic complications and major adverse cardiac events. Important data regarding much larger groups of these patient cohorts will emerge over the next year, to help guide the broader application of DES in "real-world" practice.
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Affiliation(s)
- Charles A Simonton
- Sanger Clinic, PA, Carolinas Heart Institute, Charlotte, North Carolina, USA
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Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, Kowalchuk GJ, Bersin RM, Van Moore A, Simonton CA, Rittase RA, Norton HJ, Kennedy TP. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291:2328-34. [PMID: 15150204 DOI: 10.1001/jama.291.19.2328] [Citation(s) in RCA: 848] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Contrast-induced nephropathy remains a common complication of radiographic procedures. Pretreatment with sodium bicarbonate is more protective than sodium chloride in animal models of acute ischemic renal failure. Acute renal failure from both ischemia and contrast are postulated to occur from free-radical injury. However, no studies in humans or animals have evaluated the efficacy of sodium bicarbonate for prophylaxis against contrast-induced nephropathy. OBJECTIVE To examine the efficacy of sodium bicarbonate compared with sodium chloride for preventive hydration before and after radiographic contrast. DESIGN, SETTING, AND PATIENTS A prospective, single-center, randomized trial conducted from September 16, 2002, to June 17, 2003, of 119 patients with stable serum creatinine levels of at least 1.1 mg/dL (> or =97.2 micromol/L) who were randomized to receive a 154-mEq/L infusion of either sodium chloride (n = 59) or sodium bicarbonate (n = 60) before and after iopamidol administration (370 mg iodine/mL). Serum creatinine levels were measured at baseline and 1 and 2 days after contrast. INTERVENTIONS Patients received 154 mEq/L of either sodium chloride or sodium bicarbonate, as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast, followed by an infusion of 1 mL/kg per hour for 6 hours after the procedure. MAIN OUTCOME MEASURE Contrast-induced nephropathy, defined as an increase of 25% or more in serum creatinine within 2 days of contrast. RESULTS There were no significant group differences in age, sex, incidence of diabetes mellitus, ethnicity, or contrast volume. Baseline serum creatinine was slightly higher but not statistically different in patients receiving sodium bicarbonate treatment (mean [SD], 1.71 [0.42] mg/dL [151.2 [37.1] micromol/L] for sodium chloride and 1.89 [0.69] mg/dL [167.1 [61.0] micromol/L] for sodium bicarbonate; P =.09). The primary end point of contrast-induced nephropathy occurred in 8 patients (13.6%) infused with sodium chloride but in only 1 (1.7%) of those receiving sodium bicarbonate (mean difference, 11.9%; 95% confidence interval [CI], 2.6%-21.2%; P =.02). A follow-up registry of 191 consecutive patients receiving prophylactic sodium bicarbonate and meeting the same inclusion criteria as the study resulted in 3 cases of contrast-induced nephropathy (1.6%; 95% CI, 0%-3.4%). CONCLUSION Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with sodium chloride for prophylaxis of contrast-induced renal failure.
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Affiliation(s)
- Gregory J Merten
- Department of Internal Medicine, Sanger Cardiology, Sanger Cardiovascular Surgery, and Metrolina Nephrology, Carolinas Medical Center, Charlotte, NC 28232, USA
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Moussa I, Leon MB, Baim DS, O'Neill WW, Popma JJ, Buchbinder M, Midwall J, Simonton CA, Keim E, Wang P, Kuntz RE, Moses JW. Impact of Sirolimus-Eluting Stents on Outcome in Diabetic Patients. Circulation 2004; 109:2273-8. [PMID: 15123524 DOI: 10.1161/01.cir.0000129767.45513.71] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Randomized clinical trials have shown that a sirolimus-eluting stent significantly reduces restenosis after percutaneous coronary revascularization. Diabetic patients are known to have a higher risk of restenosis compared with nondiabetic patients. The purpose of this analysis was to determine the impact of sirolimus-eluting stents on outcomes of diabetic compared with nondiabetic patients.
Methods and Results—
The SIRIUS (SIRolImUS-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) trial is a randomized, double-blind study that compared sirolimus-eluting and bare metal stent implantation in 1058 patients with de novo native coronary artery lesions. Diabetes mellitus was present in 279 (26%) patients (diabetes mellitus group, 131 patients received sirolimus-eluting stents and 148 patients received bare metal stents) and was absent in 778 patients (no–diabetes mellitus group, 402 patients received sirolimus-eluting stents and 376 patients received bare metal stents). At 270 days, target lesion revascularization was reduced in diabetic patients from 22.3% with bare metal stents to 6.9% with sirolimus-eluting stents (
P
<0.001) and in nondiabetic patients from 14.1% to 2.99% (
P
<0.001), respectively. Major adverse cardiac events were reduced in diabetic patients from 25% with bare metal stents to 9.2% with sirolimus-eluting stents (
P
<0.001) and from 16.5% to 6.5% (
P
<0.001) in nondiabetic patients, respectively.
Conclusions—
Implantation of sirolimus-eluting stents compared with bare metal stents in de novo coronary lesions reduces major adverse cardiac events in patients with and without diabetes mellitus. However, among patients receiving sirolimus-eluting stents, there remains a trend toward a higher frequency of repeat intervention in diabetic patients compared with nondiabetic patients, particularly in the insulin-requiring patients.
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Affiliation(s)
- Issam Moussa
- Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, 130 East 77th St, 9th Floor, New York, NY 10021, USA.
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Simonton CA, Brodie B, Cheek B, San G, Krainin F, Walker P, Laurent S. 1044-58 Drug-eluting stent utilization and outcomes from the strategic evaluation of new transvascular therapies (STENT) group: A large prospective multicenter “Real-World” registry of percutaneous coronary intervention. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Simonton CA. Chronic total occlusions: a new frontier. J Invasive Cardiol 2004; 16 Suppl B:1-2. [PMID: 23573630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ako J, Morino Y, Honda Y, Sonoda S, Terashima M, Hassan A, Jaeger JJ, Simonton CA, Roberts DK, Cleman MW, Leon MB, Moses JW, Yock PG, Fitzgerald PJ. Effects of sirolimus-eluting stents in diabetic patients: Volumetric intravascular ultrasound analysis from the SIRIUS trial. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Simonton CA. Directional coronary atherectomy: optimal atherectomy trials and new combined strategies with coronary stents. Semin Interv Cardiol 2000; 5:193-8. [PMID: 11244516 DOI: 10.1053/siic.2000.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Directional coronary atherectomy (DCA) has evolved from its early use as a tool for minimal plaque debulking to its current use of more aggressive lumen enlargement. The trend toward improved lumen results and reduced restenosis following DCA compared to percutaneous transluminal coronary angioplasty (PTCA) in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) was confirmed as a significant improvement in the subsequent Balloon versus Optimal Atherectomy Trial (BOAT). BOAT showed that acute lumen results and late angiographic restenosis could be significantly improved by DCA over PTCA, without any increase in procedural complications or late cardiac events. The role of DCA in conjunction with coronary stents is currently being defined as studies suggest that residual plaque burden after stenting is predictive of late restenosis. The Atherectomy before Multilink Stent Improves Lumen Gain and Clinical Outcomes Study (AMIGO) will help determine whether plaque debulking prior to stenting can reduce restenosis.
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Fitzgerald PJ, Oshima A, Hayase M, Metz JA, Bailey SR, Baim DS, Cleman MW, Deutsch E, Diver DJ, Leon MB, Moses JW, Oesterle SN, Overlie PA, Pepine CJ, Safian RD, Shani J, Simonton CA, Smalling RW, Teirstein PS, Zidar JP, Yeung AC, Kuntz RE, Yock PG. Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study. Circulation 2000; 102:523-30. [PMID: 10920064 DOI: 10.1161/01.cir.102.5.523] [Citation(s) in RCA: 294] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) can assess stent geometry more accurately than angiography. Several studies have demonstrated that the degree of stent expansion as measured by IVUS directly correlated to clinical outcome. However, it is unclear if routine ultrasound guidance of stent implantation improves clinical outcome as compared with angiographic guidance alone. METHODS AND RESULTS The CRUISE (Can Routine Ultrasound Influence Stent Expansion) study, a multicenter study IVUS substudy of the Stent Anti-thrombotic Regimen Study, was designed to assess the impact of IVUS on stent deployment in the high-pressure era. Nine centers were prospectively assigned to stent deployment with the use of ultrasound guidance and 7 centers to angiographic guidance alone with documentary (blinded) IVUS at the conclusion of the procedure. A total of 525 patients were enrolled with completed quantitative coronary angiography, quantitative coronary ultrasound, and clinical events adjudicated at 9 months for 499 patients. The IVUS-guided group had a larger minimal lumen diameter (2.9+/-0.4 versus 2.7+/-0. 5 mm, P<0.001) by quantitative coronary angiography and a larger minimal stent area (7.78+/-1.72 versus 7.06+/-2.13 mm(2), P<0.001) by quantitative coronary ultrasound. Target vessel revascularization, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 9 month-follow-up, occurred significantly less frequently in the IVUS-guided group (8.5% versus 15.3%, P<0.05; relative reduction of 44%). CONCLUSIONS These data suggest that ultrasound guidance of stent implantation may result in more effective stent expansion compared with angiographic guidance alone.
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Affiliation(s)
- P J Fitzgerald
- Stanford University Medical Center, Stanford, CA 94305-5246, USA
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