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van den Broek WWA, Gimbel ME, Hermanides RS, Runnett C, Storey RF, Knaapen P, Emans ME, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Stoel MG, von Birgelen C, van Bergen PFMM, Brinckman SL, Aksoy I, Liem A, Van't Hof AWJ, Jukema JW, Heestermans AACM, Nicastia D, Alber H, Austin D, Nasser A, Deneer V, Ten Berg JM. The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome. Int J Cardiol 2024; 405:131940. [PMID: 38458385 DOI: 10.1016/j.ijcard.2024.131940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. RESULTS The total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01-2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65-2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. CONCLUSIONS In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.
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Affiliation(s)
- W W A van den Broek
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - M E Gimbel
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology, Zwolle, the Netherlands
| | - C Runnett
- Northumbria Healthcare NHS Foundation Trust, Department of Cardiology, Newcastle, United Kingdom
| | - R F Storey
- University of Sheffield, Division of Clinical Medicine, Sheffield, United Kingdom
| | - P Knaapen
- Amsterdam University Medical Centre, Department of Cardiology, Amsterdam, the Netherlands
| | - M E Emans
- Ikazia Hospital, Department of Cardiology, Rotterdam, the Netherlands
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, the Netherlands
| | - J Cooke
- Chesterfield Royal Hospital NHS Foundation Trust, Department of Cardiology, Chesterfield, United Kingdom
| | - G Galasko
- Blackpool Teaching Hospital NHS Foundation Trust, Department of Cardiology, Blackpool, United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology, Ede, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands
| | - Paul F M M van Bergen
- Dijklander Hospital, Department of Cardiology, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - S L Brinckman
- Department of Cardiology, Tergooi MC, Blaricum, the Netherlands
| | - I Aksoy
- Admiraal de Ruyter Hospital, Department of Cardiology, Goes, the Netherlands
| | - A Liem
- Franciscus Gasthuis, Department of Cardiology, Rotterdam, the Netherlands
| | - A W J Van't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Zuyderland Medical Centre, Department of Cardiology, Heerlen, the Netherlands
| | - J W Jukema
- Leids University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - A A C M Heestermans
- Department of Cardiology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - D Nicastia
- Department of Cardiology, Gelre Hospital, Apeldoorn, the Netherlands
| | - H Alber
- KABEG Klinikum, Department for Internal Medicine and Cardiology, Klagenfurt am Wörthersee, Austria
| | - D Austin
- The James Cook University Hospital, Academic Cardiovascular Unit, Middlesbrough, United Kingdom
| | - A Nasser
- South Tyneside and Sunderland NHS Foundation Trust, Department of Cardiology, South Shields, United Kingdom
| | - V Deneer
- Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - J M Ten Berg
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
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Somsen YB, Porouchani S, de Winter RW, Zandbergen HR, Jansen EK, Nap A, Niessen HW, Knaapen P. Unmasking of a Giant Coronary Aneurysm by Chronic Total Coronary Occlusion Percutaneous Coronary Intervention Techniques. JACC Case Rep 2024; 29:102359. [PMID: 38725652 PMCID: PMC11079459 DOI: 10.1016/j.jaccas.2024.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/12/2024]
Abstract
A young female patient presenting with a non-ST-segment elevation myocardial infarction underwent invasive coronary angiography, revealing a total occlusion of the right coronary artery. During percutaneous coronary intervention with dual catheter access, a retrograde tip injection and peculiar retrograde wiring unmasked a giant coronary aneurysm, which noninvasive imaging confirmed.
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Affiliation(s)
- Yvemarie B.O. Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sina Porouchani
- Department of Cardiology, Lille University Hospital, Lille, France
| | - Ruben W. de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harmen R. Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Evert K. Jansen
- Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hans W.M. Niessen
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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3
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van Veelen A, Coerkamp CF, Somsen YBO, Råmunddal T, Ioanes D, Laanmets P, van der Schaaf RJ, Eriksen E, Bax M, Suttorp MJ, Strauss BH, Barbato E, Marques KM, Meuwissen M, Bertrand O, van der Ent M, Knaapen P, Tijssen JGP, Claessen BEPM, Hoebers LPC, Elias J, Henriques JPS. Ten-Year Outcome of Recanalization or Medical Therapy for Concomitant Chronic Total Occlusion After Myocardial Infarction. J Am Heart Assoc 2024; 13:e033556. [PMID: 38726918 DOI: 10.1161/jaha.123.033556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/21/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The EXPLORE (Evaluating Xience and Left Ventricular Function in PCI on Occlusions After STEMI) trial was the first and only randomized trial investigating chronic total occlusion (CTO) percutaneous coronary intervention (PCI) early after primary PCI for ST-segment-elevation myocardial infarction, compared with medical therapy for the CTO. We performed a 10-year follow-up of EXPLORE to investigate long-term safety and clinical impact of CTO PCI after ST-segment-elevation myocardial infarction, compared with no-CTO PCI. METHODS AND RESULTS In EXPLORE, 302 patients post-ST-segment-elevation myocardial infarction with concurrent CTO were randomized to CTO PCI within ≈1 week or no-CTO PCI. We performed an extended clinical follow-up for the primary end point of major adverse cardiac events, consisting of cardiovascular death, coronary artery bypass grafting, or myocardial infarction. Secondary end points included all-cause death, angina, and dyspnea. Median follow-up was 10 years (interquartile range, 8-11 years). The primary end point occurred in 25% of patients with CTO PCI and in 24% of patients with no-CTO PCI (hazard ratio [HR], 1.11 [95% CI, 0.70-1.76]). Cardiovascular mortality was higher in the CTO PCI group (HR, 2.09 [95% CI, 1.10-2.50]), but all-cause death was similar (HR, 1.53 [95% CI, 0.93-2.50]). Dyspnea relief was more frequent after CTO PCI (83% versus 65%, P=0.005), with no significant difference in angina. CONCLUSIONS This 10-year follow-up of patients post-ST-segment-elevation myocardial infarction randomized to CTO PCI or no-CTO PCI demonstrated no clinical benefit of CTO PCI in major adverse cardiac events or overall mortality. However, CTO PCI was associated with a higher cardiovascular mortality compared with no-CTO PCI. Our long-term data support a careful weighing of effective symptom relief against an elevated cardiovascular mortality risk in CTO PCI decisions. REGISTRATION URL: https://www.trialregister.nl; Unique identifier: NTR1108.
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Affiliation(s)
- Anna van Veelen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Casper F Coerkamp
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Truls Råmunddal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Dan Ioanes
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Peep Laanmets
- Department of Cardiology North-Estonia Medical Center Tallinn Estonia
| | | | - Erlend Eriksen
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Matthijs Bax
- Department of Cardiology Haga Teaching Hospital The Hague the Netherlands
| | | | - Bradley H Strauss
- Department of Cardiology Sunnybrook Health Sciences Centre Toronto Canada
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine Sapienza University of Rome Rome Italy
| | - Koen M Marques
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | | | - Olivier Bertrand
- Department of Cardiology Quebec Heart-Lung Institute Quebec Canada
| | | | - Paul Knaapen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Loes P C Hoebers
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
- Department of Cardiology Maastricht UMC+ Maastricht the Netherlands
| | - Joëlle Elias
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - José P S Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
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Ibrahim S, Reeskamp LF, de Goeij JN, Hovingh GK, Planken RN, Bax WA, Min JK, Earls JP, Knaapen P, Wiegman A, Stroes ESG, Nurmohamed NS. Beyond early LDL cholesterol lowering to prevent coronary atherosclerosis in familial hypercholesterolaemia. Eur J Prev Cardiol 2024; 31:892-900. [PMID: 38243822 DOI: 10.1093/eurjpc/zwae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
AIMS Familial hypercholesterolaemia (FH) patients are subjected to a high lifetime exposure to low density lipoprotein cholesterol (LDL-C), despite use of lipid-lowering therapy (LLT). This study aimed to quantify the extent of subclinical atherosclerosis and to evaluate the association between lifetime cumulative LDL-C exposure and coronary atherosclerosis in young FH patients. METHODS AND RESULTS Familial hypercholesterolaemia patients, divided into a subgroup of early treated (LLT initiated <25 years) and late treated (LLT initiated ≥25 years) patients, and an age- and sex-matched unaffected control group, underwent coronary CT angiography (CCTA) with artificial intelligence-guided analysis. Ninety genetically diagnosed FH patients and 45 unaffected volunteers (mean age 41 ± 3 years, 51 (38%) female) were included. Familial hypercholesterolaemia patients had higher cumulative LDL-C exposure (181 ± 54 vs. 105 ± 33 mmol/L ∗ years) and higher prevalence of coronary plaque compared with controls (46 [51%] vs. 10 [22%], OR 3.66 [95%CI 1.62-8.27]). Every 75 mmol/L ∗ years cumulative exposure to LDL-C was associated with a doubling in per cent atheroma volume (total plaque volume divided by total vessel volume). Early treated patients had a modestly lower cumulative LDL-C exposure compared with late treated FH patients (167 ± 41 vs. 194 ± 61 mmol/L ∗ years; P = 0.045), without significant difference in coronary atherosclerosis. Familial hypercholesterolaemia patients with above-median cumulative LDL-C exposure had significantly higher plaque prevalence (OR 3.62 [95%CI 1.62-8.27]; P = 0.001), compared with patients with below-median exposure. CONCLUSION Lifetime exposure to LDL-C determines coronary plaque burden in FH, underlining the need of early as well as potent treatment initiation. Periodic CCTA may offer a unique opportunity to monitor coronary atherosclerosis and personalize treatment in FH.
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Affiliation(s)
- Shirin Ibrahim
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jim N de Goeij
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - James P Earls
- Cleerly Inc., Denver, CO, USA
- The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, 0037 DC, USA
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Albert Wiegman
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, 0037 DC, USA
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
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5
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Boerhout CKM, Vink CEM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Impact of sex on the assessment of the microvascular resistance reserve. Int J Cardiol 2024; 402:131832. [PMID: 38316189 DOI: 10.1016/j.ijcard.2024.131832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The microvascular resistance reserve (MRR) is an innovative index to assess the vasodilatory capacity of the coronary circulation while accounting for the presence of concomitant epicardial disease. The MRR has shown to be a valuable diagnostic and prognostic tool in the general coronary artery disease (CAD) population. However, considering the fundamental aspects of its assessment and the unique hemodynamic characteristics of women, it is crucial to provide additional considerations for evaluating the MRR specifically in women. AIM The aim of this study was to assess the diagnostic and prognostic applicability of the MRR in women and assess the potential differences across different sexes. METHODS From the ILIAS Registry, we enrolled all patients with a stable indication for invasive coronary angiography, ensuring complete physiological and follow-up data. We analyzed the diagnostic value by comparing differences between sexes and evaluated the prognostic value of the MRR specifically in women, comparing it to that in men. RESULTS A total of 1494 patients were included of which 26% were women. The correlation between MRR and CFR was good and similar between women (r = 0.80, p < 0.005) and men (r = 0.81, p < 0.005). The MRR was an independent and important predictor of MACE in both women (HR 0.67, 0.47-0.96, p = 0.027) and men (HR 0.84, 0.74-0.95, p = 0.007). The optimal cut-off value for MRR in women was 2.8 and 3.2 in men. An abnormal MRR similarly predicted MACE at 5-year follow-up in both women and men. CONCLUSION The MRR seems to be equally applicable in both women and men with stable coronary artery disease.
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Affiliation(s)
| | - C E M Vink
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | | | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, Daegu, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, the Netherlands.
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Hoshino M, Jukema RA, Pijls N, Hoek R, Raijmakers P, Driessen R, van Diemen P, Twisk J, van der Hoef T, Danad I, Kakuta T, Knaapen P. Microvascular resistance reserve before and after PCI: A serial FFR and [ 15O] H 2O PET study. Atherosclerosis 2024:117555. [PMID: 38702268 DOI: 10.1016/j.atherosclerosis.2024.117555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND AIMS Microvascular Resistance Reserve (MRR) has recently been introduced as a microvasculature-specific index and hypothesized to be independent of coronary stenosis. The aim of this study was to investigate the change of MRR after percutaneous coronary intervention (PCI). METHODS In this post-hoc analysis from the PACIFC trials, symptomatic patients underwent [15O]H2O positron emission tomography (PET) and invasive fractional flow reserve (FFR) before and after revascularization. Coronary flow reserve (CFR) from PET and invasive FFR were used to calculate MRR. RESULTS Among 52 patients (87 % male, age 59.4 ± 9.4 years), 61 vessels with a median FFR of 0.71 (95 % confidence interval: 0.55 to 0.74) and a mean MRR of 3.80 ± 1.23 were included. Following PCI, FFR, hyperemic myocardial blood flow (hMBF) and CFR increased significantly (all p-values ≤0.001). MRR remained unchanged after PCI (3.80 ± 1.23 before PCI versus 3.60 ± 0.97 after PCI; p=0.23). In vessels with a pre-PCI, FFR ≤0.70 pre- and post-PCI MRR were 3.90 ± 1.30 and 3.73 ± 1.14 (p=0.56), respectively. Similar findings were observed for vessels with a FFR between 0.71 and 0.80 (pre-PCI MRR 3.70 ± 1.17 vs. post PCI MRR 3.48 ± 0.76, p=0.19). CONCLUSIONS Our study indicates that MRR, assessed using a hybrid approach of PET and invasive FFR, is independent of the severity of epicardial stenosis. These findings suggest that MRR is a microvasculature-specific parameter.
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Affiliation(s)
- Masahiro Hoshino
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan
| | - Ruurt A Jukema
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Nico Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Roel Hoek
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Pieter Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Roel Driessen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Pepijn van Diemen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Jos Twisk
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tim van der Hoef
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
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7
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van Veelen A, Verstraelen TE, Somsen YBO, Elias J, van Dongen IM, Delnoy PPHM, Scholten MF, Boersma LVA, Maass AH, Strikwerda S, Firouzi M, Allaart CP, Vernooy K, Grauss RW, Tukkie R, Knaapen P, Zwinderman AH, Dijkgraaf MGW, Claessen BEPM, van Barreveld M, Wilde AAM, Henriques JPS. Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO-IT)) Registry. J Am Heart Assoc 2024; 13:e032033. [PMID: 38591264 DOI: 10.1161/jaha.123.032033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort. METHODS AND RESULTS This is a subanalysis of the nationwide Dutch-Outcome in ICD Therapy (DO-IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all-cause mortality and appropriate ICD shocks. Clinical follow-up was conducted for at least 2 years. A total of 336 patients were included, with an average age of 67±9 years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow-up period of 27 months (interquartile range, 24-32), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27; P=0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03-3.22]; P=0.038). CONCLUSIONS Within this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all-cause mortality and appropriate ICD shocks.
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Affiliation(s)
- Anna van Veelen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Joëlle Elias
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Ivo M van Dongen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | | | - Marcoen F Scholten
- Department of Cardiology Thorax Center Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
- Department of Cardiology St. Antonius Hospital Nieuwegein The Netherlands
| | - Alexander H Maass
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | | | - Mehran Firouzi
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Kevin Vernooy
- Department of Cardiology Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+) Maastricht The Netherlands
| | - Robert W Grauss
- Department of Cardiology Haaglanden Medical Center The Hague The Netherlands
| | - Raymond Tukkie
- Department of Cardiology Spaarne Gasthuis Haarlem The Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Aeilko H Zwinderman
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Marit van Barreveld
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
- Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands
- Methodology Amsterdam Public Health Amsterdam The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - José P S Henriques
- Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
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8
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Somsen YBO, de Winter RW, Schumacher SP, van Veelen A, van Diemen PA, Jukema RA, Hoek R, Stuijfzand WJ, Danad I, Twisk JWR, Verouden NJ, Appelman Y, Nap A, Kleijn SA, Henriques JP, Knaapen P. Impact of sex on myocardial perfusion following percutaneous coronary intervention of chronic total coronary occlusions. Cardiovasc Revasc Med 2024:S1553-8389(24)00166-0. [PMID: 38658269 DOI: 10.1016/j.carrev.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/14/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES We sought to investigate the impact of sex on myocardial perfusion changes following chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) as measured by [15O]H2O positron-emission tomography (PET) perfusion imaging. BACKGROUND CTO PCI has been associated with an increase in myocardial perfusion, yet females are less likely to undergo revascularization. As such, data on the impact of sex on myocardial perfusion following CTO PCI is scarce. METHODS A total of 212 patients were prospectively enrolled and underwent CTO PCI combined with [15O]H2O PET perfusion imaging prior to and 3 months after PCI. Hyperemic myocardial blood flow (hMBF, mL·min-1·g-1) and coronary flow reserve (CFR) allocated to the CTO territory were quantitatively assessed. RESULTS This study comprised 34 (16 %) females and 178 (84 %) males. HMBF at baseline did not differ between sexes. Females showed a higher increase in hMBF than males (Δ1.34 ± 0.67 vs. Δ1.06 ± 0.74, p = 0.044), whereas post-PCI hMBF was comparable (2.59 ± 0.85 in females vs. 2.28 ± 0.84 in males, p = 0.052). Female sex was independently associated with a higher increase in hMBF after correction for clinical covariates. CFR increase after revascularization was similar in females and males (Δ1.47 ± 0.99 vs. Δ1.30 ± 1.14, p = 0.711). CONCLUSIONS The present study demonstrates a greater recovery of stress perfusion in females compared to males as measured by serial [15O]H2O PET imaging. In addition, a comparable increase in CFR was found in females and males. These results emphasize the benefit of performing CTO PCI in both sexes. CLINICAL PERSPECTIVE What is new? What are the clinical implications?
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Affiliation(s)
- Yvemarie B O Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Anna van Veelen
- Department of Cardiology Amsterdam UMC, AMC, Amsterdam, the Netherlands.
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Roel Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Wynand J Stuijfzand
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Niels J Verouden
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Sebastiaan A Kleijn
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - José P Henriques
- Department of Cardiology Amsterdam UMC, AMC, Amsterdam, the Netherlands.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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9
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Dahdal J, Bakker F, Svanerud J, Danad I, Driessen RS, Raijmakers PG, Harms HJ, Lammertsma AA, van de Hoef TP, Appelman Y, van Royen N, Knaapen P, de Waard GA. Validation of resting full-cycle ratio and diastolic pressure ratio with [ 15O]H 2O positron emission tomography myocardial perfusion. Heart Vessels 2024; 39:299-309. [PMID: 38367040 PMCID: PMC10920410 DOI: 10.1007/s00380-023-02356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/18/2023] [Indexed: 02/19/2024]
Abstract
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive techniques used to evaluate the hemodynamic significance of coronary artery stenosis. These methods have been validated through perfusion imaging and clinical trials. New invasive pressure ratios that do not require hyperemia have recently emerged, and it is essential to confirm their diagnostic efficacy. The aim of this study was to validate the resting full-cycle ratio (RFR) and the diastolic pressure ratio (dPR), against [15O]H2O positron emission tomography (PET) imaging. A total of 129 symptomatic patients with an intermediate risk of coronary artery disease (CAD) were included. All patients underwent cardiac [15O]H2O PET with quantitative assessment of resting and hyperemic myocardial perfusion. Within a 2 week period, coronary angiography was performed. Intracoronary pressure measurements were obtained in 320 vessels and RFR, dPR, and FFR were computed. PET derived regional hyperemic myocardial blood flow (hMBF) and myocardial perfusion reserve (MPR) served as reference standards. In coronary arteries with stenoses (43%, 136 of 320), the overall diagnostic accuracies of RFR, dPR, and FFR did not differ when PET hyperemic MBF < 2.3 ml min-1 (69.9%, 70.6%, and 77.1%, respectively) and PET MPR < 2.5 (70.6%, 71.3%, and 66.9%, respectively) were considered as the reference for myocardial ischemia. Non-significant differences between the areas under the receiver operating characteristic (ROC) curve were found between the different indices. Furthermore, the integration of FFR with RFR (or dPR) does not enhance the diagnostic information already achieved by FFR in the characterization of ischemia via PET perfusion. In conclusion, the novel non-hyperemic pressure ratios, RFR and dPR, have a diagnostic performance comparable to FFR in assessing regional myocardial ischemia. These findings suggest that RFR and dPR may be considered as an FFR alternative for invasively guiding revascularization treatment in symptomatic patients with CAD.
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Affiliation(s)
- Jorge Dahdal
- Department of Cardiology, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Cardiology, Hospital Del Salvador, Salvador 364, 7500922, Santiago, Chile
| | - Frank Bakker
- Department of Cardiology, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Johan Svanerud
- Coroventis Research AB, Ulls Väg 29A, 75651, Uppsala, Sweden
| | - Ibrahim Danad
- Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hendrik J Harms
- Clinical Institute, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Tim P van de Hoef
- Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Guus A de Waard
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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10
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Dobrolinska MM, Jukema RA, van Velzen SGM, van Diemen PA, Greuter MJW, Prakken NHJ, van der Werf NR, Raijmakers PG, Slart RHJA, Knaapen P, Isgum I, Danad I. The prognostic value of visual and automatic coronary calcium -scoring from low dose CT-[15O]-water PET. Eur Heart J Cardiovasc Imaging 2024:jeae081. [PMID: 38525588 DOI: 10.1093/ehjci/jeae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE Firstly, to validate automatically and visually scored coronary artery calcium (CAC) on low dose CT (LDCT) scans with a dedicated calcium scoring CT (CSCT) scan. Secondly, to assess the added value of CAC scored from LDCT scans acquired during [15O]-water-PET myocardial perfusion imaging (MPI) on prediction of major adverse cardiac events (MACE). METHODS 572 consecutive patients with suspected coronary artery disease, who underwent [15O]-water-PET MPI with LDCT and a dedicated CSCT scan were included. In the reference CSCT scans, manual CAC scoring was performed, while LDCT scans were scored visually and automatically using deep learning approach. Subsequently, based on CAC score results from CSCT and LDCT scans, each patient's scan was assigned to one out of five cardiovascular risk groups (0; 1-100; 101-400; 401-1000; >1000) and the agreement in risk group classification between CSCT and LDCT scans was investigated. MACE was defined as a composite of all-cause death, nonfatal myocardial infarction, coronary revascularization, and unstable angina. RESULTS The agreement in risk group classification between reference CSCT manual scoring and visual/automatic LDCT scoring from LDCT was 0.66 (95% CI: 0.62-0.70) and 0.58 (95% CI: 0.53-0.62), respectively. Based on visual and automatic CAC scoring from LDCT scans, patients with CAC>100 and CAC>400, respectively, were at increased risk of MACE, independently of ischemic information from the [15O]-water-PET scan. CONCLUSIONS There is a moderate agreement in risk classification between visual and automatic CAC scoring from LDCT and reference CSCT scans. Visual and automatic CAC scoring from LDCT scans improve identification of patients at higher risk of MACE.
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Affiliation(s)
- M M Dobrolinska
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - R A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - S G M van Velzen
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - P A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M J W Greuter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, Netherlands
| | - N H J Prakken
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - N R van der Werf
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117
| | - R H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - P Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - I Isgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, the Netherlands
| | - I Danad
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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11
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Nurmohamed NS, Danad I, Jukema RA, de Winter RW, de Groot RJ, Driessen RS, Bom MJ, van Diemen P, Pontone G, Andreini D, Chang HJ, Katz RJ, Stroes ESG, Wang H, Chan C, Crabtree T, Aquino M, Min JK, Earls JP, Bax JJ, Choi AD, Knaapen P, van Rosendael AR. Development and Validation of a Quantitative Coronary CT Angiography Model for Diagnosis of Vessel-Specific Coronary Ischemia. JACC Cardiovasc Imaging 2024:S1936-878X(24)00039-1. [PMID: 38483420 DOI: 10.1016/j.jcmg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/30/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Noninvasive stress testing is commonly used for detection of coronary ischemia but possesses variable accuracy and may result in excessive health care costs. OBJECTIVES This study aimed to derive and validate an artificial intelligence-guided quantitative coronary computed tomography angiography (AI-QCT) model for the diagnosis of coronary ischemia that integrates atherosclerosis and vascular morphology measures (AI-QCTISCHEMIA) and to evaluate its prognostic utility for major adverse cardiovascular events (MACE). METHODS A post hoc analysis of the CREDENCE (Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia) and PACIFIC-1 (Comparison of Coronary Computed Tomography Angiography, Single Photon Emission Computed Tomography [SPECT], Positron Emission Tomography [PET], and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve) studies was performed. In both studies, symptomatic patients with suspected stable coronary artery disease had prospectively undergone coronary computed tomography angiography (CTA), myocardial perfusion imaging (MPI), SPECT, or PET, fractional flow reserve by CT (FFRCT), and invasive coronary angiography in conjunction with invasive FFR measurements. The AI-QCTISCHEMIA model was developed in the derivation cohort of the CREDENCE study, and its diagnostic performance for coronary ischemia (FFR ≤0.80) was evaluated in the CREDENCE validation cohort and PACIFIC-1. Its prognostic value was investigated in PACIFIC-1. RESULTS In CREDENCE validation (n = 305, age 64.4 ± 9.8 years, 210 [69%] male), the diagnostic performance by area under the receiver-operating characteristics curve (AUC) on per-patient level was 0.80 (95% CI: 0.75-0.85) for AI-QCTISCHEMIA, 0.69 (95% CI: 0.63-0.74; P < 0.001) for FFRCT, and 0.65 (95% CI: 0.59-0.71; P < 0.001) for MPI. In PACIFIC-1 (n = 208, age 58.1 ± 8.7 years, 132 [63%] male), the AUCs were 0.85 (95% CI: 0.79-0.91) for AI-QCTISCHEMIA, 0.78 (95% CI: 0.72-0.84; P = 0.037) for FFRCT, 0.89 (95% CI: 0.84-0.93; P = 0.262) for PET, and 0.72 (95% CI: 0.67-0.78; P < 0.001) for SPECT. Adjusted for clinical risk factors and coronary CTA-determined obstructive stenosis, a positive AI-QCTISCHEMIA test was associated with an HR of 7.6 (95% CI: 1.2-47.0; P = 0.030) for MACE. CONCLUSIONS This newly developed coronary CTA-based ischemia model using coronary atherosclerosis and vascular morphology characteristics accurately diagnoses coronary ischemia by invasive FFR and provides robust prognostic utility for MACE beyond presence of stenosis.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robin J de Groot
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Richard J Katz
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hao Wang
- Cleerly Inc, Denver, Colorado, USA
| | | | | | | | | | - James P Earls
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Cleerly Inc, Denver, Colorado, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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12
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Nurmohamed NS, Bom MJ, Jukema RA, de Groot RJ, Driessen RS, van Diemen PA, de Winter RW, Gaillard EL, Sprengers RW, Stroes ESG, Min JK, Earls JP, Cardoso R, Blankstein R, Danad I, Choi AD, Knaapen P. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. JACC Cardiovasc Imaging 2024; 17:269-280. [PMID: 37480907 DOI: 10.1016/j.jcmg.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The recent development of artificial intelligence-guided quantitative coronary computed tomography angiography analysis (AI-QCT) has enabled rapid analysis of atherosclerotic plaque burden and characteristics. OBJECTIVES This study set out to investigate the 10-year prognostic value of atherosclerotic burden derived from AI-QCT and to compare the spectrum of plaque to manually assessed coronary computed tomography angiography (CCTA), coronary artery calcium scoring (CACS), and clinical risk characteristics. METHODS This was a long-term follow-up study of 536 patients referred for suspected coronary artery disease. CCTA scans were analyzed with AI-QCT and plaque burden was classified with a plaque staging system (stage 0: 0% percentage atheroma volume [PAV]; stage 1: >0%-5% PAV; stage 2: >5%-15% PAV; stage 3: >15% PAV). The primary major adverse cardiac event (MACE) outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, and all-cause mortality. RESULTS The mean age at baseline was 58.6 years and 297 patients (55%) were male. During a median follow-up of 10.3 years (IQR: 8.6-11.5 years), 114 patients (21%) experienced the primary outcome. Compared to stages 0 and 1, patients with stage 3 PAV and percentage of noncalcified plaque volume of >7.5% had a more than 3-fold (adjusted HR: 3.57; 95% CI 2.12-6.00; P < 0.001) and 4-fold (adjusted HR: 4.37; 95% CI: 2.51-7.62; P < 0.001) increased risk of MACE, respectively. Addition of AI-QCT improved a model with clinical risk factors and CACS at different time points during follow-up (10-year AUC: 0.82 [95% CI: 0.78-0.87] vs 0.73 [95% CI: 0.68-0.79]; P < 0.001; net reclassification improvement: 0.21 [95% CI: 0.09-0.38]). Furthermore, AI-QCT achieved an improved area under the curve compared to Coronary Artery Disease Reporting and Data System 2.0 (10-year AUC: 0.78; 95% CI: 0.73-0.83; P = 0.023) and manual QCT (10-year AUC: 0.78; 95% CI: 0.73-0.83; P = 0.040), although net reclassification improvement was modest (0.09 [95% CI: -0.02 to 0.29] and 0.04 [95% CI: -0.05 to 0.27], respectively). CONCLUSIONS Through 10-year follow-up, AI-QCT plaque staging showed important prognostic value for MACE and showed additional discriminatory value over clinical risk factors, CACS, and manual guideline-recommended CCTA assessment.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA. https://twitter.com/NickNurmohamed
| | - Michiel J Bom
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robin J de Groot
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Emilie L Gaillard
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Ralf W Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - James P Earls
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Cleerly Inc, Denver, Colorado, USA
| | - Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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13
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de Winter RW, van Diemen PA, Schumacher SP, Jukema RA, Somsen YBO, Hoek R, van Rossum AC, Twisk JWR, de Waard GA, Nap A, Raijmakers PG, Driessen RS, Knaapen P, Danad I. Hemodynamic Insights into Combined Fractional Flow Reserve and Instantaneous Wave-Free Ratio Assessment Through Quantitative [ 15O]H 2O PET Myocardial Perfusion Imaging. J Nucl Med 2024; 65:279-286. [PMID: 38176722 DOI: 10.2967/jnumed.123.265973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/01/2023] [Indexed: 01/06/2024] Open
Abstract
In patients evaluated for obstructive coronary artery disease (CAD), guidelines recommend using either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) to guide coronary revascularization decision-making. The hemodynamic significance of lesions with discordant FFR and iFR measurements is debated. This study compared [15O]H2O PET-derived absolute myocardial perfusion between vessels with concordant and discordant FFR and iFR measurements. Methods: We included 197 patients suspected of obstructive CAD who had undergone [15O]H2O PET perfusion imaging and combined FFR/iFR interrogation in 468 vessels. Resting myocardial blood flow (MBF), hyperemic MBF, and coronary flow reserve (CFR) were compared among 4 groups: FFR low/iFR low (n = 79), FFR high/iFR low (n = 22), FFR low/iFR high (n = 22), and FFR high/iFR high (n = 345). Predefined [15O]H2O PET thresholds for ischemia were 2.3 mL·min-1·g-1 or less for hyperemic MBF and 2.5 or less for CFR. Results: Hyperemic MBF was lower in the concordant low (2.09 ± 0.67 mL·min-1·g-1), FFR high/iFR low (2.41 ± 0.80 mL·min-1·g-1), and FFR low/iFR high (2.40 ± 0.69 mL·min-1·g-1) groups compared with the concordant high group (2.91 ± 0.84 mL·min-1·g-1) (P < 0.001, P = 0.004, and P < 0.001, respectively). A lower CFR was observed in the concordant low (2.37 ± 0.76) and FFR high/iFR low (2.64 ± 0.84) groups compared with the concordant high group (3.35 ± 1.07, P < 0.01 for both). However, for vessels with either low FFR or low iFR, quantitative hyperemic MBF and CFR values exceeded the ischemic threshold in 38% and 49%, respectively. In addition, resting MBF exhibited a negative correlation with iFR (P < 0.001) and was associated with FFR low/iFR high discordance compared with concordant low FFR/low iFR measurements, independent of clinical and angiographic characteristics, as well as hyperemic MBF (odds ratio [OR], 0.41; 95% CI, 0.26-0.65; P < 0.001). Conclusion: We found reduced myocardial perfusion in vessels with concordant low and discordant FFR/iFR measurements. However, FFR/iFR combinations often inaccurately classified vessels as either ischemic or nonischemic when compared with hyperemic MBF and CFR. Furthermore, a lower resting MBF was associated with a higher iFR and the occurrence of FFR low/iFR high discordance. Our study showed that although combined FFR/iFR assessment can be useful to estimate the hemodynamic significance of coronary lesions, these pressure-derived indices provide a limited approximation of [15O]H2O PET-derived quantitative myocardial perfusion as the physiologic standard of CAD severity.
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Affiliation(s)
- Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine, and PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Gimbel ME, Chan Pin Yin DRPP, van den Broek WWA, Hermanides RS, Kauer F, Tavenier AH, Schellings D, Brinckman SL, The SHK, Stoel MG, Heestermans TACM, Rasoul S, Emans ME, van de Wetering M, van Bergen PFMM, Walhout R, Nicastia D, Aksoy I, van 't Hof A, Knaapen P, Botman CJ, Liem A, de Nooijer C, Peper J, Kelder JC, Ten Berg JM. Treatment of elderly patients with non-ST-elevation myocardial infarction: the nationwide POPular age registry. Neth Heart J 2024; 32:84-90. [PMID: 37768542 PMCID: PMC10834918 DOI: 10.1007/s12471-023-01812-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in a national registry. METHODS The POPular AGE registry is a prospective, multicentre study of patients ≥ 75 years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician. Cardiovascular events consisted of cardiovascular death, myocardial infarction and ischaemic stroke. Bleeding was classified according to the Bleeding Academic Research Consortium (BARC) criteria. RESULTS A total of 646 patients were enrolled between August 2016 and May 2018. Median age was 81 (IQR 77-84) years and 58% were male. Overall, 75% underwent coronary angiography, 40% percutaneous coronary intervention, and 11% coronary artery bypass grafting, while 49.8% received pharmacological therapy only. At discharge, dual antiplatelet therapy (aspirin and P2Y12 inhibitor) was prescribed to 56.7%, and 27.4% received oral anticoagulation plus at least one antiplatelet agent. At 1‑year follow-up, cardiovascular death, myocardial infarction or stroke had occurred in 13.6% and major bleeding (BARC 3 and 5) in 3.9% of patients. The risk of both cardiovascular events and major bleeding was highest during the 1st month. However, cardiovascular risk was three times as high as bleeding risk in this elderly population, both after 1 month and after 1 year. CONCLUSIONS In this national registry of elderly patients with NSTEMI, the majority are treated according to current European Society of Cardiology guidelines. Both the cardiovascular and bleeding risk are highest during the 1st month after NSTEMI. However, the cardiovascular risk was three times as high as the bleeding risk.
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Affiliation(s)
- Marieke E Gimbel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | | | | | | | - Floris Kauer
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Dirk Schellings
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | | | - Salem H K The
- Department of Cardiology, Treant Hospitals, Emmen, The Netherlands
| | - Martin G Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Saman Rasoul
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre and , Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Mireille E Emans
- Department of Cardiology, Ikazia Hospital, Rotterdam, The Netherlands
| | | | | | - Ronald Walhout
- Department of Cardiology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Debby Nicastia
- Department of Cardiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Ismail Aksoy
- Department of Cardiology, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Arnoud van 't Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre and , Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Cees-Joost Botman
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Anho Liem
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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15
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van Rosendael AR, Crabtree T, Bax JJ, Nakanishi R, Mushtaq S, Pontone G, Andreini D, Buechel RR, Gräni C, Feuchtner G, Patel TR, Choi AD, Al-Mallah M, Nabi F, Karlsberg RP, Rochitte CE, Alasnag M, Hamdan A, Cademartiri F, Marques H, Kalra D, German DM, Gupta H, Hadamitzky M, Deaño RC, Khalique O, Knaapen P, Hoffmann U, Earls J, Min JK, Danad I. Rationale and design of the CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) study. J Cardiovasc Comput Tomogr 2024; 18:11-17. [PMID: 37951725 PMCID: PMC10923095 DOI: 10.1016/j.jcct.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND In the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total coronary plaque volume and low attenuation plaque volume. The primary aim of CONFIRM2, (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is to perform comprehensive quantification of CCTA findings, including coronary, non-coronary cardiac, non-cardiac vascular, non-cardiac findings, and relate them to clinical variables and cardiovascular clinical outcomes. DESIGN CONFIRM2 is a multicenter, international observational cohort study designed to evaluate multidimensional associations between quantitative phenotype of cardiovascular disease and future adverse clinical outcomes in subjects undergoing clinically indicated CCTA. The targeted population is heterogenous and includes patients undergoing CCTA for atherosclerotic evaluation, valvular heart disease, congenital heart disease or pre-procedural evaluation. Automated software will be utilized for quantification of coronary plaque, stenosis, vascular morphology and cardiac structures for rapid and reproducible tissue characterization. Up to 30,000 patients will be included from up to 50 international multi-continental clinical CCTA sites and followed for 3-4 years. SUMMARY CONFIRM2 is one of the largest CCTA studies to establish the clinical value of a multiparametric approach to quantify the phenotype of cardiovascular disease by CCTA using automated imaging solutions.
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Affiliation(s)
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Toral R Patel
- Cardiology at Stroobants Heart and Vascular Institute and UVA Cardiology, Lynchburg, VA, United States of America
| | - Andrew D Choi
- Cardiology and Radiology, George Washington University, Washington, DC, United States of America
| | - Mouaz Al-Mallah
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Cedars Sinai Heart Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Filippo Cademartiri
- Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy & SYNLAB IRCCS SDN, Naples, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa and Católica Medical School, Portugal
| | - Dinesh Kalra
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - David M German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States of America
| | - Himanshu Gupta
- Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Ridgewood, NJ, United States of America
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Roderick C Deaño
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Omar Khalique
- Division of Cardiovascular Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands
| | - Udo Hoffmann
- Cleerly, Inc, Denver, CO, United States of America
| | - James Earls
- Cleerly, Inc, Denver, CO, United States of America
| | - James K Min
- Cleerly, Inc, Denver, CO, United States of America
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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16
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van Diemen PA, de Winter RW, Schumacher SP, Everaars H, Bom MJ, Jukema RA, Somsen YB, Raijmakers PG, Kooistra RA, Timmer J, Maaniitty T, Robbers LF, von Bartheld MB, Demirkiran A, van Rossum AC, Reiber JH, Knuuti J, Underwood SR, Nagel E, Knaapen P, Driessen RS, Danad I. The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease. Eur Heart J Cardiovasc Imaging 2023; 25:116-126. [PMID: 37578007 PMCID: PMC10735295 DOI: 10.1093/ehjci/jead197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
AIMS In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)]. METHODS AND RESULTS This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001). CONCLUSION QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD.
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Affiliation(s)
- Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Yvemarie B Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Lourens F Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Martin B von Bartheld
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | | | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
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17
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Lansky AJ, Xu B, Baumbach A, Kelbæk H, van Royen N, Zheng M, Knaapen P, Slagboom T, Johnson TW, Vlachojannis GJ, Arkenbout KE, Holmvang L, Janssens L, Brugaletta S, Naber CK, Schmitz T, Anderson R, Rittger H, Berti S, Barbato E, Toth GG, Maillard L, Valina CM, Buszman PE, Thiele H, Schächinger V, Wijns W. Targeted therapy with a localised abluminal groove, low-dose sirolimus-eluting, biodegradable-polymer coronary stent - five-year results of the TARGET All Comers randomised clinical trial. EUROINTERVENTION 2023; 19:e844-e855. [PMID: 37860860 PMCID: PMC10687649 DOI: 10.4244/eij-d-23-00409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND In the prospective, multicentre, randomised TARGET All Comers study, percutaneous coronary intervention (PCI) with the FIREHAWK biodegradable-polymer sirolimus-eluting stent (BP-SES) was non-inferior to the durable-polymer everolimus-eluting stent (DP-EES) for the primary endpoint of target lesion failure (TLF) at 12 months. AIMS We aimed to report the final study outcomes at 5 years. METHODS Patients referred for PCI were randomised to receive either a BP-SES or DP-EES in a 1:1 ratio in 10 European countries. Randomisation was stratified by centre and ST-elevation myocardial infarction (STEMI) presentation, and clinical follow-up extended to 5 years. The primary endpoint was TLF (composite of cardiac death, target vessel myocardial infarction [MI], or ischaemia-driven target lesion revascularisation). Secondary endpoints included patient-oriented composite events (POCE; composite of all-cause death, all MI, or any revascularisation and its components). RESULTS From December 2015 to October 2016, 1,653 patients were randomly assigned to the BP-SES or DP-EES groups, of which 93.8% completed 5-year clinical follow-up or were deceased. At 5 years, TLF occurred in 17.1% of the BP-SES group and in 16.3% of the DP-EES group (p=0.68). POCE occurred in 34.0% of the BP-SES group and 32.7% of the DP-EES group (p=0.58). Revascularisation was the most common POCE, occurring in 19.3% of patients receiving BP-SES and 19.2% receiving DP-EES, of which less than one-third was ischaemia-driven target lesion-related. In the landmark analysis, there were no differences in the rates of TLF and POCE between groups from 1 to 5 years, and these results were consistent across all subgroups. CONCLUSIONS In an all-comers population requiring stent implantation for myocardial ischaemia, the BP-SES was non-inferior to the DP-EES for the primary endpoint of TLF at 12 months, and results were sustained at 5 years, confirming the long-term safety and efficacy of the FIREHAWK BP-SES.
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Affiliation(s)
- Alexandra J Lansky
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, CT, USA
| | - Bo Xu
- Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andreas Baumbach
- Barts Heart Centre and Queen Mary University of London, London, United Kingdom
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Niels van Royen
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ming Zheng
- Shanghai MicroPort Medical (Group) Co., Ltd. Shanghai, China
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ton Slagboom
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Thomas W Johnson
- Bristol Heart Institute, University of Bristol, and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luc Janssens
- Heart Centre, Imeldaziekenhuis, Bonheiden, Belgium
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clínic de Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christoph K Naber
- Contilia Heart and Vascular Center, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Thomas Schmitz
- Contilia Heart and Vascular Center, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Richard Anderson
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Sergio Berti
- UOC Cardiologia Diagnostica e Interventistica, Ospedale del Cuore, Fondazione C.N.R. Regione Toscana G. Monasterio, Massa, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Luc Maillard
- Service de Cardiologie, Clinique Axium, Aix-en-Provence, France
| | - Christian M Valina
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Paweł E Buszman
- American Heart of Poland, Katowice, Poland
- Department of Epidemiology and Biostatistics, Medical School of Silesia, Katowice, Poland
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Volker Schächinger
- Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda, Fulda, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine and CURAM, University of Galway, and Saolta University Health Care Group, University Hospital Galway, Galway, Ireland
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18
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Eftekhari A, van de Hoef TP, Hoshino M, Lee JM, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia-Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Effat MA, Marques K, Doh JH, Banerjee R, Nam CW, Niccoli G, Murai T, Nakayama M, Tanaka N, Shin ES, Knaapen P, van Royen N, Escaned J, Koo BK, Chamuleau SAJ, Kakuta T, Piek JJ, Christiansen EH. Changes in microvascular resistance following percutaneous coronary intervention - From the ILIAS global registry. Int J Cardiol 2023; 392:131296. [PMID: 37633364 DOI: 10.1016/j.ijcard.2023.131296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/08/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Microvascular resistance (MR) has prognostic value in acute and chronic coronary syndromes following percutaneous coronary intervention (PCI), however anatomic and physiologic determinants of the relative changes of MR and its association to target vessel failure (TVF) has not been investigated previously. This study aims to evaluate the association between changes in MR and TVF. METHODS This is a sub-study of the Inclusive Invasive Physiological Assessment in Angina Syndromes (ILIAS) registry which is a global multi-centre initiative pooling lesion-level coronary pressure and flow data. RESULTS Paired pre-post PCI haemodynamic data were available in n = 295 vessels out of n = 828 PCI treated patients and of these paired data on MR was present in n = 155 vessels. Vessels were divided according to increase vs. decrease % in microvascular resistance following PCI (ΔMR % ≤ 0 vs. ΔMR > 0%). Decreased microvascular resistance ΔMR % ≤ 0 occurred in vessels with lower pre-PCI fractional flow reserve (0.67 ± 0.15 vs. 0.72 ± 0.09 p = 0.051), coronary flow reserve (1.9 ± 0.8 vs. 2.6 ± 1.8 p < 0.0001) and higher hyperemic microvascular resistance (2.76 ± 1.3 vs. 1.62 ± 0.74 p = 0.001) and index of microvascular resistance (24.4 IQ (13.8) vs. 15. 8 IQ (13.2) p = 0.004). There was no difference in angiographic parameters between ΔMR % ≤ 0 vs. ΔMR > 0%. In a cox regression model ΔMR % > 0 was associated with increased rate of TVF (hazard ratio 95% CI 3.6 [1.2; 10.3] p = 0.018). CONCLUSION Increased MR post-PCI was associated with lesions of less severe hemodynamic influence at baseline and higher rates of TVF at follow-up.
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Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Medicine Hearth Vascular Stroke Institute Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Mauro Echavarria-Pinto
- Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estad Querétaro, Facultad de Medicina Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Hearth Center, Gifu, Japan
| | | | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | | | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
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19
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Yang S, Hwang D, Lee JM, Lee SH, Boerhout CK, Woudstra J, Vink CE, de Waard GA, Jung JH, Renteria HM, Hoshino M, Pinto ME, Meuwissen M, Matsuo H, Cambero MM, Eftekhari A, Effat MA, Murai T, Marques K, Appelman Y, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Beijk MA, Chamuleau SA, van Royen N, Knaapen P, Kakuta T, Escaned J, Piek JJ, van de Hoef TP, Koo BK. Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters. JACC Asia 2023; 3:865-877. [PMID: 38155797 PMCID: PMC10751649 DOI: 10.1016/j.jacasi.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 12/30/2023]
Abstract
Background Coronary pressure- and flow-derived parameters have prognostic value. Objectives This study aims to investigate the individual and combined prognostic relevance of pressure and flow parameters reflecting resting and hyperemic conditions. Methods A total of 1,971 vessels deferred from revascularization after invasive pressure and flow assessment were included from the international multicenter registry. Abnormal resting pressure and flow were defined as distal coronary pressure/aortic pressure ≤0.92 and high resting flow (1/resting mean transit time >2.4 or resting average peak flow >22.7 cm/s), and abnormal hyperemic pressure and flow as fractional flow reserve ≤0.80 and low hyperemic flow (1/hyperemic mean transit time <2.2 or hyperemic average peak flow <25.0 cm/s), respectively. The clinical endpoint was target vessel failure (TVF), myocardial infarction (MI), or cardiac death at 5 years. Results The mean % diameter stenosis was 46.8% ± 16.5%. Abnormal pressure and flow were independent predictors of TVF and cardiac death/MI (all P < 0.05). The risk of 5-year TVF or MI/cardiac death increased proportionally with neither, either, and both abnormal resting pressure and flow, and abnormal hyperemic pressure and flow (all P for trend < 0.001). Abnormal resting pressure and flow were associated with a higher rate of TVF or MI/cardiac death in vessels with normal fractional flow reserve; this association was similar for abnormal hyperemic pressure and flow in vessels with normal resting distal coronary pressure/aortic pressure (all P < 0.05). Conclusions Abnormal resting and hyperemic pressure and flow were independent prognostic predictors. The abnormal flow had an additive prognostic value for pressure in both resting and hyperemic conditions with complementary prognostic between resting and hyperemic parameters.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Coen K.M. Boerhout
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Caitlin E.M. Vink
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Guus A. de Waard
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ji Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Mauro Echavarria Pinto
- Hospital General ISSSTE Querétaro Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A. Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joon Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
- Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Marcel A.M. Beijk
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Steven A.J. Chamuleau
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Jan J. Piek
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Tim P. van de Hoef
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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20
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Jonas R, Patel T, Crabtree TR, Jennings RS, Heo R, Park HB, Marques H, Chang HJ, Stuijfzand WJ, Rosendael ARV, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Al-Mallah MH, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Bax JJ, Choi AD, Earls JP, Hoffmann U, Min JK, Villines TC. Corrigendum to 'Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity' The American Journal of Cardiology, Volume 204, 1 October 2023, Pages 276-283. Am J Cardiol 2023; 207:523. [PMID: 37925201 DOI: 10.1016/j.amjcard.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Rebecca Jonas
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
| | - Toral Patel
- Department of Cardiology and Advanced Cardiac Imaging, Centra Heart and Vascular Institute, Lynchburg, Virginia
| | | | | | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, Alabama
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Ryo Nakazato
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - U Joseph Schoepf
- Department of Cardiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Roel S Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel J Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - James J Jang
- Kaiser Permanente San Jose Medical Center, San Jose, California
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, Nevada
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary's Hospital, Athens, Georgia
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Guus A de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan Italy; Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan Italy; Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew D Choi
- Department of Radiology, Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | | | | | | | - Todd C Villines
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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21
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Vink CEM, Woudstra J, Lee JM, Boerhout CKM, Cook CM, Hoshino M, Mejia-Renteria H, Lee SH, Jung JH, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Beijk MAM, Doh JH, Piek JJ, van de Hoef TP, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Appelman Y, de Waard GA. Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry. Atherosclerosis 2023; 384:117167. [PMID: 37558604 DOI: 10.1016/j.atherosclerosis.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes. METHODS In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured. Patients were stratified into groups: 1) obstructive coronary artery disease (oCAD) (FFR≤0.80, no revascularization), 2) undergoing revascularization, 3) non-obstructive coronary artery disease with coronary microvascular dysfunction (CMD) (FFR>0.80, CFR≤2.5), and 4) non-obstructive coronary artery disease without CMD (FFR>0.80 and CFR>2.5). RESULTS 1836 patients (2335 vessels) were included, comprising 1359 (74.0%) men and 477 (26.0%) women. oCAD was present in 14.1% and was significantly less prevalent in women than in men (10.3% vs 15.5%, respectively p < 0.01). Revascularization was present in 30.9% and was similarly prevalent in women and men (28.2% vs. 31.9%, respectively p = 0.13). CMD was present in 24.2% and was significantly more prevalent in women than men (28.6% vs 22.6%, respectively p < 0.01). Normal invasive measurements were found in 564 patients (33.0% women vs 30.0% men, p = 0.23). Male sex was associated with an increased risk of target vessel failure compared to women (HR.1.89, 95% CI 1.12-3.18, p = 0.018), regardless of CCS-endotype. CONCLUSIONS Sex differences exist in the prevalence and outcomes of different endotypes of CCS in symptomatic patients undergoing invasive coronary angiography. In particular, oCAD (and subsequent revascularization) were more prevalent in men. Conversely, CMD was more prevalent in women. Overall, men experienced a worse cardiovascular outcome compared to women, independent of any specific CCS endotype.
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Affiliation(s)
- Caitlin E M Vink
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Christopher M Cook
- The Essex Cardiothoracic Centre, Essex, United Kingdom; Anglia Ruskin University, Essex, United Kingdom
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, Republic of Korea
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands.
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22
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Stegehuis V, Boerhout C, Kikuta Y, Cambero-Madera M, van Royen N, Matsuo H, Nakayama M, de Waard G, Knaapen P, Nijjer S, Petraco R, Siebes M, Davies J, Escaned J, van de Hoef T, Piek J. Impact of stenosis resistance and coronary flow capacity on fractional flow reserve and instantaneous wave-free ratio discordance: a combined analysis of DEFINE-FLOW and IDEAL. Neth Heart J 2023; 31:434-443. [PMID: 37594612 PMCID: PMC10602988 DOI: 10.1007/s12471-023-01796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15-20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking. AIMS We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance. METHODS We assessed pressure and flow measurements of 647 intermediate lesions (593 patients) of two multi-centre international studies. RESULTS FFR and iFR were discordant in 15% of all lesions (97 out of 647). FFR+/iFR- lesions had similar hyperaemic average peak velocity (hAPV), CFR and CFC as FFR-/iFR- lesions, whereas FFR-/iFR+ lesions had similar hAPV, CFR and CFC as FFR+/iFR+ lesions (p > 0.05 for all). FFR+/iFR- lesions were associated with lower baseline stenosis resistance, but not hyperaemic stenosis resistance, compared with FFR-/iFR+ lesions (p < 0.001). CONCLUSIONS Discordance with FFR+/iFR- is characterised by maximal flow values, CFR, and CFC patterns similar to FFR-/iFR- concordance that justifies conservative therapy. Discordance with FFR-/iFR+ on the other hand, is characterised by low flow values, CFR, and CFC patterns similar to iFR+/FFR+ concordance that may benefit from percutaneous coronary intervention.
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Affiliation(s)
- Valérie Stegehuis
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Coen Boerhout
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | | | - Guus de Waard
- Amsterdam UMC-location VUMC, Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, VU University, Amsterdam, The Netherlands
| | - Paul Knaapen
- Amsterdam UMC-location VUMC, Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, VU University, Amsterdam, The Netherlands
| | | | | | - Maria Siebes
- Department of Biomedical Engineering and Physics, Amsterdam UMC-location AMC, Amsterdam, The Netherlands
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Tim van de Hoef
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Piek
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.
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23
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Somsen YBO, de Winter RW, Giunta R, Schumacher SP, van Diemen PA, Jukema RA, Stuijfzand WJ, Danad I, Lissenberg-Witte BI, Verouden NJ, Nap A, Kleijn SA, Galassi AR, Henriques JP, Knaapen P. Collateral grading systems in retrograde percutaneous coronary intervention of chronic total occlusions. Catheter Cardiovasc Interv 2023; 102:844-856. [PMID: 37671770 DOI: 10.1002/ccd.30812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/08/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The Japanese Channel (J-Channel) score was introduced to aid in retrograde percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs). The predictive value of the J-Channel score has not been compared with established collateral grading systems such as the Rentrop classification and Werner grade. AIMS To investigate the predictive value of the J-Channel score, Rentrop classification and Werner grade for successful collateral channel (CC) guidewire crossing and technical CTO PCI success. METHODS A total of 600 prospectively recruited patients underwent CTO PCI. All grading systems were assessed under dual catheter injection. CC guidewire crossing was considered successful if the guidewire reached the distal segment of the CTO vessel through a retrograde approach. Technical CTO PCI success was defined as thrombolysis in myocardial infarction flow grade 3 and residual stenosis <30%. RESULTS Of 600 patients, 257 (43%) underwent CTO PCI through a retrograde approach. Successful CC guidewire crossing was achieved in 208 (81%) patients. The predictive value of the J-Channel score for CC guidewire crossing (area under curve 0.743) was comparable with the Rentrop classification (0.699, p = 0.094) and superior to the Werner grade (0.663, p = 0.002). Technical CTO PCI success was reported in 232 (90%) patients. The Rentrop classification exhibited a numerically higher discriminatory ability (0.676) compared to the J-Channel score (0.664) and Werner grade (0.589). CONCLUSIONS The J-channel score might aid in strategic collateral channel selection during retrograde CTO PCI. However, the J-Channel score, Rentrop classification, and Werner grade have limited value in predicting technical CTO PCI success.
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Affiliation(s)
- Yvemarie B O Somsen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rocco Giunta
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Stefan P Schumacher
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruurt A Jukema
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wijnand J Stuijfzand
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, University of Utrecht, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Niels J Verouden
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander Nap
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sebastiaan A Kleijn
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - José P Henriques
- Department of Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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24
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Jukema RA, de Winter RW, Hopman LHGA, Driessen RS, van Diemen PA, Appelman Y, Twisk JWR, Planken RN, Raijmakers PG, Knaapen P, Danad I. Impact of cardiac history and myocardial scar on increase of myocardial perfusion after revascularization. Eur J Nucl Med Mol Imaging 2023; 50:3897-3909. [PMID: 37561140 PMCID: PMC10611874 DOI: 10.1007/s00259-023-06356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue. METHODS Symptomatic patients underwent [15O]H2O positron emission tomography (PET) and FFR before and after revascularization. Patients with prior CAD, defined as prior MI or PCI, underwent scar quantification by magnetic resonance imaging late gadolinium enhancement. RESULTS Among 137 patients (87% male, age 62.2 ± 9.5 years) 84 (61%) had a prior MI or PCI. The increase in FFR and hyperemic myocardial blood flow (hMBF) was less in patients with prior MI or non-MI PCI compared to those without a cardiac history (FFR: 0.23 ± 0.14 vs. 0.20 ± 0.12 vs. 0.31 ± 0.18, p = 0.02; hMBF: 0.54 ± 0.75 vs. 0.62 ± 0.97 vs. 0.91 ± 0.96 ml/min/g, p = 0.04). Post-revascularization FFR and hMBF were similar across patients without a cardiac history or with prior MI or non-MI PCI. An increase in FFR was strongly associated to hMBF increase in patients without a cardiac history or with prior MI/non-MI PCI (r = 0.60 and r = 0.60, p < 0.01 for both). Similar results were found for coronary flow reserve. In patients with prior MI scar was negatively correlated to hMBF increase and independently predictive of an attenuated CFR increase. CONCLUSIONS Post revascularization FFR and perfusion were similar among patients without a cardiac history, with prior MI or non-MI PCI. In patients with prior MI scar burden was associated to an attenuated perfusion increase.
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Affiliation(s)
- Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yolande Appelman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R Nils Planken
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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25
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Loh SX, Brilakis E, Gasparini G, Agostoni P, Garbo R, Mashayekhi K, Alaswad K, Goktiken O, Avran A, Knaapen P, Nap A, Elguindi A, Tammam K, Yamane M, Stone GW, Egred M. Coils embolization use for coronary procedures: Basics, indications, and techniques. Catheter Cardiovasc Interv 2023; 102:900-911. [PMID: 37668102 DOI: 10.1002/ccd.30821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
The use of coils is fundamental in interventional cardiology and can be lifesaving in selected settings. Coils are classified by their materials into bare metal, fiber coated, and hydrogel coated, or by the deliverability method into, pushable or detachable coils. Coils are delivered through microcatheters and the choice of coil size is important to ensure compatibility with the inner diameter of the delivery catheter, firstly to be able to deliver and secondly to prevent the coil from being stuck and damaged. Clinically, coils are used in either acute or in elective setting. The most important acute indication is typically the sealing coronary perforation. In the elective settings, coils can be used for the treatment of certain congenital cardiac abnormalities, aneurysms, fistulas or in the treatment of arterial side branch steal syndrome after CABG. Coils must always be delivered under fluoroscopy guidance. There are some associated complications with coils that can be acute or chronic, that nictitates regular followed-up. There is a need for education, training and regular workshops with hands-on to build the experience to use coils in situations that are infrequently encountered.
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Affiliation(s)
- Shu Xian Loh
- Cardiothoracic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Emmanuelle Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Roberto Garbo
- Interventional Cardiology Department, Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Kambis Mashayekhi
- Internal Medicine and Cardiology, MediClin Heartcenter, Herzzentrum Lahr, Hohbergweg, Germany
| | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | | | | | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alex Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ahmed Elguindi
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- School of Medicine, University of Sunderland, Sunderland, UK
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26
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Holm NR, Andreasen LN, Neghabat O, Laanmets P, Kumsars I, Bennett J, Olsen NT, Odenstedt J, Hoffmann P, Dens J, Chowdhary S, O'Kane P, Bülow Rasmussen SH, Heigert M, Havndrup O, Van Kuijk JP, Biscaglia S, Mogensen LJH, Henareh L, Burzotta F, H Eek C, Mylotte D, Llinas MS, Koltowski L, Knaapen P, Calic S, Witt N, Santos-Pardo I, Watkins S, Lønborg J, Kristensen AT, Jensen LO, Calais F, Cockburn J, McNeice A, Kajander OA, Heestermans T, Kische S, Eftekhari A, Spratt JC, Christiansen EH. OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions. N Engl J Med 2023; 389:1477-1487. [PMID: 37634149 DOI: 10.1056/nejmoa2307770] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [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: 08/29/2023]
Abstract
BACKGROUND Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. METHODS We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. RESULTS We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P = 0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. CONCLUSIONS Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.).
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Affiliation(s)
- Niels R Holm
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Lene N Andreasen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Omeed Neghabat
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Peep Laanmets
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Indulis Kumsars
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Johan Bennett
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Niels T Olsen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Jacob Odenstedt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Pavel Hoffmann
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Jo Dens
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Saqib Chowdhary
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Peter O'Kane
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Søren-Haldur Bülow Rasmussen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Matthias Heigert
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Ole Havndrup
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Jan P Van Kuijk
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Simone Biscaglia
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Lone J H Mogensen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Loghman Henareh
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Francesco Burzotta
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Christian H Eek
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Darren Mylotte
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Miquel S Llinas
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Lukasz Koltowski
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Paul Knaapen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Slobodan Calic
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Nils Witt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Irene Santos-Pardo
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Stuart Watkins
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Jacob Lønborg
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Andreas T Kristensen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Lisette O Jensen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Fredrik Calais
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - James Cockburn
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Andrew McNeice
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Olli A Kajander
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Ton Heestermans
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Stephan Kische
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Ashkan Eftekhari
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - James C Spratt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
| | - Evald H Christiansen
- From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.)
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Jonas R, Patel T, Crabtree TR, Jennings RS, Heo R, Park HB, Marques H, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Al-Mallah MH, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Bax JJ, Choi AD, Earls JP, Hoffmann U, Min JK, Villines TC. Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity. Am J Cardiol 2023; 204:276-283. [PMID: 37562193 DOI: 10.1016/j.amjcard.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023]
Abstract
It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.
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Affiliation(s)
- Rebecca Jonas
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
| | - Toral Patel
- Department of Cardiology and Advanced Cardiac Imaging, Centra Heart and Vascular Institute, Lynchburg, Virginia
| | | | | | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, Alabama
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Ryo Nakazato
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - U Joseph Schoepf
- Department of Cardiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Roel S Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel J Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - James J Jang
- Kaiser Permanente San Jose Medical Center, San Jose, California
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, Nevada
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary's Hospital, Athens, Georgia
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Guus A de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gianluca Pontone
- Department of University Cardiology and Cardiac Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Department of University Cardiology and Cardiac Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew D Choi
- Department of Radiology, Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | | | | | | | - Todd C Villines
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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Ungureanu C, Yamane M, Kayaert P, Knaapen P, Mashayekhi K, Alaswad K, Spratt JC, Gasparini GL, Dens J, Lepièce C, Carlier S, Sgueglia GA, Avran A. The safety and feasibility of live-stream proctoring for CTO procedures. J Invasive Cardiol 2023; 35. [PMID: 37984322 DOI: 10.25270/jic/23.00076] [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: 11/22/2023]
Abstract
OBJECTIVE To assess the technical feasibility of a new method of educational training, based on audio-video (AV) communication between an interventional cardiologist and the cath lab staff members in one location and a remote expert proctor. METHODS Overall, 9 patients underwent a percutaneous coronary intervention (PCI) targeting a chronic total occlusion (CTO) between June 2021 and January 2022 at a single Belgian center using the virtual proctoring approach. For this assessment, the strategic planning of the CTO PCI and all the decisions throughout the intervention were the responsibility of the proctor. The operator was guided via an AV link, by the proctor throughout the procedure. RESULTS The operator performed each procedural step, guided by the remote proctor, who had continuous access to all relevant interventional details. No major adverse cardiac events (MACE) occurred during the index hospitalization or within 6 months follow-up. CONCLUSIONS A new method of virtual proctoring based on live AV communication is feasible, even in the case of highly complex CTO PCI procedures. This strategy also appears safe and may provide the patient the benefit of incremental expertise. This approach is facilitated by advances in AV communication and allows physicians to share expertise irrespective of location. It could increase global interaction between colleagues and facilitate sharing of knowledge, which are both key aspects in the development of CTO PCI. This preliminary experience could serve as a basis for future large studies to study the potential role and benefits of virtual proctoring for complex CTO PCI procedures.
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Affiliation(s)
| | | | | | - Paul Knaapen
- Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan
| | - James C Spratt
- St. George's University Hospital NHS Foundation Trust, London, UKn
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Kwiecinski J, Oleksiak A, Kruk M, Zysk A, Debski A, Knaapen P, Schumacher SP, Barbero U, Witkowski A, Kepka C, Opolski MP. Computed tomography perfusion and angiography in patients with chronic total occlusion undergoing percutaneous coronary intervention. Atherosclerosis 2023; 381:117174. [PMID: 37400307 DOI: 10.1016/j.atherosclerosis.2023.06.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND AIMS Myocardial perfusion imaging (MPI) and anatomical imaging with coronary computed tomography angiography (CCTA) can play an important role in the preprocedural planning of a chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aimed to establish the feasibility of a novel dynamic computed tomography perfusion (CTP) analysis for the assessment of myocardial perfusion before and after a successful recanalization of CTO in patients undergoing CCTA as part of a standard preprocedural workup. METHODS In a prospective observational study symptomatic patients underwent dynamic CTP on a dual-source CT scanner both before and 3 months after successful CTO PCI. RESULTS Twenty-seven patients completed the study (63 ± 8 years old, 78% male). Following successful CTO PCI, there was a significant reduction in the ischemic burden (5 [5-7] versus 1 [0-2] segments, p < 0.001), and improvement in myocardial blood flow (85.3 [71.7-94.1] versus 134.6 [123.8-156.9] mL/min, p < 0.001) resulting in an increase in the relative flow reserve (0.49 [0.41-0.57] versus 0.88 [0.74-0.95], p < 0.001). CONCLUSIONS CTP emerges as a robust and safe method for MPI in CTO patients. The single imaging session assessment of both coronary anatomy and perfusion with CT lends itself to precise disease phenotyping in the challenging population of CTO patients.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Anna Oleksiak
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Antoni Zysk
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Artur Debski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Umberto Barbero
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Santissima Annunziata Hospital, Savigliano, Italy
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Cezary Kepka
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
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30
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de Winter RW, Jukema RA, van Diemen PA, Schumacher SP, Somsen YB, van de Hoef TP, van Rossum AC, Twisk JW, Maaniitty T, Knuuti J, Saraste A, Nap A, Raijmakers PG, Danad I, Knaapen P. Prognostic Value of Modified Coronary Flow Capacity Derived From [ 15O]H 2O Positron Emission Tomography Perfusion Imaging. Circ Cardiovasc Imaging 2023; 16:e014845. [PMID: 37725672 PMCID: PMC10510823 DOI: 10.1161/circimaging.122.014845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Coronary flow capacity (CFC) is a measure that integrates hyperemic myocardial blood flow and coronary flow reserve to quantify the pathophysiological impact of coronary artery disease on vasodilator capacity. This study explores the prognostic value of modified CFC derived from [15O]H2O positron emission tomography perfusion imaging. METHODS Quantitative rest/stress perfusion measurements were obtained from 1300 patients with known or suspected coronary artery disease. Patients were classified as having myocardial steal (n=38), severely reduced CFC (n=141), moderately reduced CFC (n=394), minimally reduced CFC (n=245), or normal flow (n=482) using previously defined thresholds. The end point was a composite of death and nonfatal myocardial infarction. RESULTS During a median follow-up of 5.5 (interquartile range, 3.7-7.8) years, the end point occurred in 153 (12%) patients. Myocardial steal (hazard ratio [HR], 6.70 [95% CI, 3.21-13.99]; P<0.001), severely reduced CFC (HR, 2.35 [95% CI, 1.16-4.78]; P=0.018), and moderately reduced CFC (HR, 1.95 [95% CI, 1.11-3.41]; P=0.020) were associated with worse prognosis compared with normal flow, after adjusting for clinical characteristics. Similarly, in the overall population, increased resting myocardial blood flow (HR, 3.05 [95% CI, 1.68-5.54]; P<0.001), decreased hyperemic myocardial blood flow (HR, 0.68 [95% CI, 0.52-0.90]; P=0.007) and decreased coronary flow reserve (HR, 0.55 [95% CI, 0.42-0.71]; P<0.001) were independently associated with adverse outcome. In a model adjusted for the combined use of perfusion metrics, modified CFC demonstrated independent prognostic value (overall P=0.017). CONCLUSIONS [15O]H2O positron emission tomography-derived resting myocardial blood flow, hyperemic myocardial blood flow, coronary flow reserve, and CFC are prognostic factors for death and nonfatal myocardial infarction in patients with known or suspected coronary artery disease. Importantly, after adjustment for clinical characteristics and the combined use of [15O]H2O positron emission tomography perfusion metrics, modified CFC remained independently associated with adverse outcome.
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Affiliation(s)
- Ruben W. de Winter
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Ruurt A. Jukema
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Pepijn A. van Diemen
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Stefan P. Schumacher
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Yvemarie B.O. Somsen
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Tim P. van de Hoef
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Albert C. van Rossum
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Jos W.R. Twisk
- Epidemiology & Data Science (J.W.R.T.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Finland (T.M., J.K., A.S.)
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Finland (T.M., J.K., A.S.)
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Finland (T.M., J.K., A.S.)
| | - Alexander Nap
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Pieter G. Raijmakers
- Radiology, Nuclear Medicine & PET Research (P.G.R.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands
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31
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van den Broek WWA, Gimbel ME, Chan Pin Yin DRPP, Azzahhafi J, Hermanides RS, Runnett C, Storey RF, Austin D, Oemrawsingh R, Cooke J, Galasko G, Walhout RJ, Schellings DAAM, Brinckman SL, The HK, Stoel MG, Heestermans AACM, Nicastia D, Emans ME, van ’t Hof AWJ, Alber H, Gerber R, van Bergen PFMM, Aksoy I, Nasser A, Knaapen P, Botman CJ, Liem A, Kelder JC, ten Berg JM. Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry. J Clin Med 2023; 12:5450. [PMID: 37685517 PMCID: PMC10487667 DOI: 10.3390/jcm12175450] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort. MACE included cardiovascular death, acute coronary syndrome, and stroke. The study included 1190 patients (median age 80 years, 43% female). CAG was performed in 67% (N = 798), with two-thirds undergoing revascularization. Conservatively treated patients had higher baseline risk. After propensity score matching, 319 patient pairs were successfully matched. MACE occurred more frequently in the conservative group (total population 20% vs. 12%, adjHR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adjHR 0.50, 95% CI 0.31-0.81, p = 0.004). In conclusion, an early invasive strategy was associated with benefits over conservative management in elderly patients with NSTEMI. Risk factors associated with ischemia and bleeding should guide strategy selection rather than solely relying on age.
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Affiliation(s)
- Wout W. A. van den Broek
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Marieke E. Gimbel
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Dean R. P. P. Chan Pin Yin
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Renicus S. Hermanides
- Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands;
| | - Craig Runnett
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, 8 Silver Fox Way, Newcastle upon Tyne NE27 0QJ, UK;
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK;
| | - David Austin
- Academic Cardiovascular Unit, The James Cook University Hospital, Marton Rd., Middlesbrough TS4 3BW, UK;
| | - Rohit Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands;
| | - Justin Cooke
- Department of Cardiology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Rd., Calow, Chesterfield S44 5BL, UK;
| | - Gavin Galasko
- Department of Cardiology, Blackpool Teaching Hospital NHS Foundation Trust, Whinney Heys Rd., Blackpool FY3 8NR, UK;
| | - Ronald J. Walhout
- Department of Cardiology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands;
| | - Dirk A. A. M. Schellings
- Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands;
| | - Stijn L. Brinckman
- Department of Cardiology, Tergooi MC, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands;
| | - Hong Kie The
- Department of Cardiology, Treant Zorggroep, Boermarkeweg 60, 7824 AA Emmen, The Netherlands;
| | - Martin G. Stoel
- Department of Cardiology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands;
| | | | - Debby Nicastia
- Department of Cardiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands;
| | - Mireille E. Emans
- Department of Cardiology, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands;
| | - Arnoud W. J. van ’t Hof
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Hannes Alber
- Department for Internal Medicine and Cardiology, KABEG Klinikum, Feschnigstraße 11, 9020 Klagenfurt am Wörthersee, Austria;
| | - Robert Gerber
- Department of Cardiology, East Sussex Healthcare NHS Foundation Trust, Dane Rd., Seaford BN25 1DH, UK;
| | | | - Ismail Aksoy
- Department of Cardiology, Admiraal de Ruyter Hospital, ‘s-Gravenpolderseweg 114, 4462 RA Goes, The Netherlands;
| | - Abdul Nasser
- Department of Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Harton Ln., South Shields NE34 0PL, UK;
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
| | - Cees-Joost Botman
- Department of Cardiology, Sint Jans Gasthuis, Vogelsbleek 5, 6001 BE Weert, The Netherlands;
| | - Anho Liem
- Department of Cardiology, Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands;
| | - Johannes C. Kelder
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Jurriën M. ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
- Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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Boerhout CKM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry. Eur Heart J 2023; 44:2862-2869. [PMID: 37350567 PMCID: PMC10406337 DOI: 10.1093/eurheartj/ehad378] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
AIMS The microvascular resistance reserve (MRR) was introduced as a means to characterize the vasodilator reserve capacity of the coronary microcirculation while accounting for the influence of concomitant epicardial disease and the impact of administration of potent vasodilators on aortic pressure. This study aimed to evaluate the diagnostic and prognostic performance of MRR. METHODS AND RESULTS A total of 1481 patients with stable symptoms and a clinical indication for coronary angiography were included from the global ILIAS Registry. MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressure. The median MRR was 2.97 [Q1-Q3: 2.32-3.86] and the overall relationship between MRR and CFR was good [correlation coefficient (Rs) = 0.88, P < 0.005]. The difference between CFR and MRR increased with decreasing FFR [coefficient of determination (R2) = 0.34; Coef.-2.88, 95% confidence interval (CI): -3.05--2.73; P < 0.005]. MRR was independently associated with major adverse cardiac events (MACE) at 5-year follow-up [hazard ratio (HR) 0.78; 95% CI 0.63-0.95; P = 0.024] and with target vessel failure (TVF) at 5-year follow-up (HR 0.83; 95% CI 0.76-0.97; P = 0.047). The optimal cut-off value of MRR was 3.0. Based on this cut-off value, only abnormal MRR was significantly associated with MACE and TVF at 5-year follow-up in vessels with functionally significant epicardial disease (FFR <0.75). CONCLUSION MRR seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of MRR over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease.
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Affiliation(s)
- Coen K M Boerhout
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Guus A de Waard
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, South Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, 20 Gyeyangmunhwa-ro, Gyeyang-gu, Incheon, South Korea
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro—Facultad de Medicina, Universidad Autónoma de Querétaro, Av Tecnológico 101, Las Campanas, 76000 Santiago de Querétaro, México
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Maribel Madera-Cambero
- Department of Cardiology, Tergooi Hospital, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyangsi, Gyeonggi-do, Goyang, South Korea
| | - Evald H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
- Research Services, Veteran Affairs Medical Center, 3200 Vine St, Cincinnati, OH 45220, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, 1095 Dalgubeol-daero, Sindang-dong, Dalseo-gu, Daegu, South Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, 296-12 Changgyeonggung-ro, Jongno-gu, Seoul, Rome, Italy
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
- Cardiovascular Center, Toda Central General Hospital, 1 Chome-19-3 Honcho, Toda, Saitama 335-0023, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Zuid-Korea, Ulsan, Dong-gu 25, South Korea
| | - Yolande Appelman
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Paul Knaapen
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, South Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim P van de Hoef
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Kuronuma K, van Diemen PA, Han D, Lin A, Grodecki K, Kwiecinski J, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial. J Nucl Cardiol 2023; 30:1558-1569. [PMID: 36645580 DOI: 10.1007/s12350-022-03194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/02/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Positron emission tomography (PET) is the clinical gold standard for quantifying myocardial blood flow (MBF). Pericoronary adipose tissue (PCAT) attenuation may detect vascular inflammation indirectly. We examined the relationship between MBF by PET and plaque burden and PCAT on coronary CT angiography (CCTA). METHODS This post hoc analysis of the PACIFIC trial included 208 patients with suspected coronary artery disease (CAD) who underwent [15O]H2O PET and CCTA. Low-attenuation plaque (LAP, < 30HU), non-calcified plaque (NCP), and PCAT attenuation were measured by CCTA. RESULTS In 582 vessels, 211 (36.3%) had impaired per-vessel hyperemic MBF (≤ 2.30 mL/min/g). In multivariable analysis, LAP burden was independently and consistently associated with impaired hyperemic MBF (P = 0.016); over NCP burden (P = 0.997). Addition of LAP burden improved predictive performance for impaired hyperemic MBF from a model with CAD severity and calcified plaque burden (P < 0.001). There was no correlation between PCAT attenuation and hyperemic MBF (r = - 0.11), and PCAT attenuation was not associated with impaired hyperemic MBF in univariable or multivariable analysis of all vessels (P > 0.1). CONCLUSION In patients with stable CAD, LAP burden was independently associated with impaired hyperemic MBF and a stronger predictor of impaired hyperemic MBF than NCP burden. There was no association between PCAT attenuation and hyperemic MBF.
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Affiliation(s)
- Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | | | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Guadalupe Flores Tomasino
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
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van Velzen SGM, Dobrolinska MM, Knaapen P, van Herten RLM, Jukema R, Danad I, Slart RHJA, Greuter MJW, Išgum I. Automated cardiovascular risk categorization through AI-driven coronary calcium quantification in cardiac PET acquired attenuation correction CT. J Nucl Cardiol 2023; 30:955-969. [PMID: 35851642 PMCID: PMC10261233 DOI: 10.1007/s12350-022-03047-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND We present an automatic method for coronary artery calcium (CAC) quantification and cardiovascular risk categorization in CT attenuation correction (CTAC) scans acquired at rest and stress during cardiac PET/CT. The method segments CAC according to visual assessment rather than the commonly used CT-number threshold. METHODS The method decomposes an image containing CAC into a synthetic image without CAC and an image showing only CAC. Extensive evaluation was performed in a set of 98 patients, each having rest and stress CTAC scans and a dedicated calcium scoring CT (CSCT). Standard manual calcium scoring in CSCT provided the reference standard. RESULTS The interscan reproducibility of CAC quantification computed as average absolute relative differences between CTAC and CSCT scan pairs was 75% and 85% at rest and stress using the automatic method compared to 121% and 114% using clinical calcium scoring. Agreement between automatic risk assessment in CTAC and clinical risk categorization in CSCT resulted in linearly weighted kappa of 0.65 compared to 0.40 between CTAC and CSCT using clinically used calcium scoring. CONCLUSION The increased interscan reproducibility achieved by our method may allow routine cardiovascular risk assessment in CTAC, potentially relieving the need for dedicated CSCT.
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Affiliation(s)
- S G M van Velzen
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands.
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands.
| | - M M Dobrolinska
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - P Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R L M van Herten
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - R Jukema
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - I Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - M J W Greuter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - I Išgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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35
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van der Sangen NMR, Claessen BEPM, Küçük IT, den Hartog AW, Baan J, Beijk MAM, Delewi R, van de Hoef TP, Knaapen P, Lemkes JS, Marques KM, Nap A, Verouden NJW, Vis MM, de Winter RJ, Kikkert WJ, Appelman Y, Henriques JPS. Single antiplatelet therapy directly after percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients: the OPTICA study. EUROINTERVENTION 2023; 19:63-72. [PMID: 36734020 PMCID: PMC10173755 DOI: 10.4244/eij-d-22-00886] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 10/09/2022] [Accepted: 12/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early P2Y12 inhibitor monotherapy has emerged as a promising alternative to 12 months of dual antiplatelet therapy following percutaneous coronary intervention (PCI). AIMS In this single-arm pilot study, we evaluated the feasibility and safety of ticagrelor or prasugrel monotherapy directly following PCI in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS Patients received a loading dose of ticagrelor or prasugrel before undergoing platelet function testing and subsequent PCI using new-generation drug-eluting stents. The stent result was adjudicated with optical coherence tomography in the first 35 patients. Ticagrelor or prasugrel monotherapy was continued for 12 months. The primary ischaemic endpoint was the composite of all-cause mortality, myocardial infarction, definite or probable stent thrombosis or stroke within 6 months. The primary bleeding endpoint was Bleeding Academic Research Consortium type 2, 3 or 5 bleeding within 6 months. RESULTS From March 2021 to March 2022, 125 patients were enrolled, of whom 75 ultimately met all in- and exclusion criteria (mean age 64.5 years, 29.3% women). Overall, 70 out of 75 (93.3%) patients were treated with ticagrelor or prasugrel monotherapy directly following PCI. The primary ischaemic endpoint occurred in 3 (4.0%) patients within 6 months. No cases of stent thrombosis or spontaneous myocardial infarction occurred. The primary bleeding endpoint occurred in 7 (9.3%) patients within 6 months. CONCLUSIONS This study provides first-in-human evidence that P2Y12 inhibitor monotherapy directly following PCI for NSTE-ACS is feasible, without any overt safety concerns, and highlights the need for randomised controlled trials comparing direct P2Y12 inhibitor monotherapy with the current standard of care.
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Affiliation(s)
- Niels M R van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - I Tarik Küçük
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Alexander W den Hartog
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Koen M Marques
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Niels J W Verouden
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - M Marije Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Wouter J Kikkert
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije University (VU), Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jose P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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Han D, van Diemen P, Kuronuma K, Lin A, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Sex differences in computed tomography angiography-derived coronary plaque burden in relation to invasive fractional flow reserve. J Cardiovasc Comput Tomogr 2023; 17:112-119. [PMID: 36670043 PMCID: PMC10148895 DOI: 10.1016/j.jcct.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Distinct sex-related differences exist in coronary artery plaque burden and distribution. We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography (CCTA) in relation to ischemia by invasive fractional flow reserve (FFR). METHODS This post-hoc analysis of the PACIFIC trial included 581 vessels in 203 patients (mean age 58.1 ± 8.7 years, 63.5% male) who underwent CCTA and per-vessel invasive FFR. Quantitative assessment of total, calcified, non-calcified, and low-density non-calcified plaque burden were performed using semiautomated software. Significant ischemia was defined as invasive FFR ≤0.8. RESULTS The per-vessel frequency of ischemia was higher in men than women (33.5% vs. 7.5%, p < 0.001). Women had a smaller burden of all plaque subtypes (all p < 0.01). There was no sex difference on total, calcified, or non-calcified plaque burdens in vessels with ischemia; only low-density non-calcified plaque burden was significantly lower in women (beta: -0.183, p = 0.035). The burdens of all plaque subtypes were independently associated with ischemia in both men and women (For total plaque burden (5% increase): Men, OR: 1.15, 95%CI: 1.06-1.24, p = 0.001; Women, OR: 1.96, 95%CI: 1.11-3.46, p = 0.02). No significant interaction existed between sex and total plaque burden for predicting ischemia (interaction p = 0.108). The addition of quantitative plaque burdens to stenosis severity and adverse plaque characteristics improved the discrimination of ischemia in both men and women. CONCLUSIONS In symptomatic patients with suspected CAD, women have a lower CCTA-derived burden of all plaque subtypes compared to men. Quantitative plaque burden provides independent and incremental predictive value for ischemia, irrespective of sex.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Pepijn van Diemen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cardiovascular Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Artificial Interlligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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Simsek B, Tajti P, Carlino M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Rangan BV, Goktekin O, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, Azzalini L. EXTERNAL VALIDATION OF THE PROGRESS-CTO COMPLICATION RISK SCORES: INDIVIDUAL PATIENT DATA POOLED ANALYSIS OF 3 REGISTRIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Simsek B, Carlino M, Pan M, Vemmou E, Nikolakopoulos I, Kostantinis S, Karacsonyi J, Agostoni P, Alexandre A, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh SJ, Goktekin O, Allana SS, Rangan BV, Rempakos A, Choi JW, Kearney KE, Lombardi WL, Grantham JA, Hirai T, Brilakis ES, Azzalini L. VALIDATION OF THE OPEN-CLEAN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION PERFORATION SCORE IN A MULTICENTER REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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de Winter RW, Walsh SJ, Hanratty CG, Spratt JC, Sprengers RW, Twisk JWR, Vegting I, Schumacher SP, Bom MJ, Hoek R, Verouden NJ, Delewi R, Nap A, Knaapen P. Percutaneous coronary intervention of native coronary artery versus saphenous vein graft in patients with prior coronary artery bypass graft surgery: Rationale and design of the multicenter, randomized PROCTOR trial. Am Heart J 2023; 257:20-29. [PMID: 36410442 DOI: 10.1016/j.ahj.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous revascularization due to advanced age, progressive coronary artery disease and bypass graft failure. Percutaneous coronary intervention (PCI) of either the bypass graft or the native coronary artery may be performed. Randomized trials comparing native vessel PCI with bypass graft PCI are lacking and long-term outcomes have not been reported. METHODS PROCTOR (NCT03805048) is a prospective, multicenter, randomized controlled trial, that will include 584 patients presenting with saphenous vein graft (SVG) failure and a clinical indication for revascularization, as determined by the local Heart Team. The trial is designed to compare the clinical and angiographic outcomes in patients randomly allocated in a 1:1 fashion to either a strategy of native vessel PCI or SVG PCI. The primary study endpoint is a 3-year composite of major adverse cardiac events (MACE: all-cause mortality, non-fatal target coronary territory myocardial infarction [MI], or clinically driven target coronary territory revascularization). At 3-years, after evaluation of the primary endpoint, follow-up invasive coronary angiography will be performed. Secondary endpoints comprise individual components of MACE at 1, 3 and 5 years follow-up, PCI-related MI, MI >48 hours after index PCI, target vessel failure, target lesion revascularization, renal failure requiring renal-replacement therapy, angiographic outcomes at 3-years and quality of life (delta Seattle Angina Questionnaire, Canadian Cardiovascular Society Grading Scale and Rose Dyspnea Scale). CONCLUSION PROCTOR is the first randomized trial comparing an invasive strategy of native coronary artery PCI with SVG PCI in post-CABG patients presenting with SVG failure.
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Affiliation(s)
- Ruben W de Winter
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Simon J Walsh
- Department of Cardiology, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colm G Hanratty
- Heart & Vascular Centre, Mater Private Day Hospital, Dublin, Ireland
| | - James C Spratt
- Department of Cardiology, St George's University Hospital NHS Trust, London, United Kingdom
| | - Ralf W Sprengers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | - Iris Vegting
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Roel Hoek
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J Verouden
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ronak Delewi
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
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40
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Hoek R, Borodzicz-Jazdzyk S, Van Diemen P, Somsen Y, Willem De Winter R, Jukema R, Raijmakers P, Knuuti JM, Maaniitty T, Underwood SR, Nagel EC, Robbers L, Demirkiran A, von Bartheld B, Driessen R, Danad I, Gotte M, Knaapen P. DIAGNOSTIC PERFORMANCE OF QUANTITATIVE CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH PRIOR CORONARY ARTERY DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01751-5] [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: 03/06/2023]
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Winter RWD, Jukema R, Van Diemen P, Schumacher S, Somsen Y, van de Hoef TP, van Rossum A, Twisk J, Maaniitty T, Knuuti JM, Saraste A, Nap A, Raijmakers P, Danad I, Knaapen P. CORONARY FLOW CAPACITY PREDICTS ADVERSE OUTCOME BEYOND STANDARD PERFUSION METRICS IN STABLE CHEST PAIN PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Somsen Y, De Winter RW, Van Veelen A, Schumacher S, Van Diemen P, Jukema R, Hoek R, Stuijfzand W, Danad I, Verouden N, Nap A, Appelman Y, Henriques J, Knaapen P. IMPACT OF SEX-DIFFERENCES ON CHANGES IN MYOCARDIAL PERFUSION FOLLOWING PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL CORONARY OCCLUSIONS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Nurmohamed NS, Jukema R, Driessen R, Bom M, Winter RWD, Sprengers R, Nap A, Sidahmed A, Min JK, Earls JP, Choi AD, Knaapen P, Danad I. AI-QCT DEMONSTRATES SUPERIOR ACCURACY FOR THE DIAGNOSIS OF OBSTRUCTIVE CAD BY QCA STANDARD COMPARED TO CORE LAB CCTA INTERPRETATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Jukema R, Maaniitty T, van Diemen P, Berkhof H, Raijmakers PG, Sprengers R, Planken RN, Knaapen P, Saraste A, Danad I, Knuuti J. Warranty period of coronary computed tomography angiography and [15O]H2O positron emission tomography in symptomatic patients. Eur Heart J Cardiovasc Imaging 2023; 24:304-311. [PMID: 36585755 DOI: 10.1093/ehjci/jeac258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Data on the warranty period of coronary computed tomography angiography (CTA) and combined coronary CTA/positron emission tomography (PET) are scarce. The present study aimed to determine the event-free (warranty) period after coronary CTA and the potential additional value of PET. METHOD AND RESULTS Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA and/or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD, or obstructive CAD. A hyperaemic myocardial blood flow (MBF) ≤ 2.3 mL/min/g was considered abnormal. The warranty period was defined as the time for which the cumulative event rate of death and non-fatal myocardial infarction (MI) was below 5%. Of 2575 included patients (mean age 61.4 ± 9.9 years, 41% male), 1319 (51.2%) underwent coronary CTA only and 1237 (48.0%) underwent combined coronary CTA/PET. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients with no CAD on coronary CTA was ≥10 years, whereas patients with non-obstructive CAD had a 5-year warranty period. Patients with obstructive CAD and normal hyperaemic MBF had a 2-year longer warranty period compared to patients with obstructive CAD and abnormal MBF (3 years vs. 1 year). CONCLUSION As standalone imaging, the warranty period for normal coronary CTA is ≥10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Normal PET yielded a 2-year longer warranty period in patients with obstructive CAD.
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Affiliation(s)
- Ruurt Jukema
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
| | - Pepijn van Diemen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Hans Berkhof
- Department of Epidemiology & Data Science, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ralf Sprengers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Heart Center, Turku University Hospital, Turku 20520, Finland
| | - Ibrahim Danad
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
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45
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Simsek B, Carlino M, Ojeda S, Pan M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Quadros AS, Dens JA, Abi Rafeh N, Agostoni P, Alaswad K, Avran A, Belli KC, Choi JW, Elguindy A, Jaffer FA, Doshi D, Karmpaliotis D, Khatri JJ, Khelimskii D, Knaapen P, La Manna A, Krestyaninov O, Lamelas P, Padilla L, de Oliveira PP, Spratt JC, Tanabe M, Walsh S, Goktekin O, Gorgulu S, Mastrodemos OC, Allana S, Rangan BV, Kearney KE, Lombardi WL, Grantham JA, Hirai T, Brilakis ES, Azzalini L. Validation of the OPEN-CLEAN Chronic Total Occlusion Percutaneous Coronary Intervention Perforation Score in a Multicenter Registry. Am J Cardiol 2023; 188:30-35. [PMID: 36462272 DOI: 10.1016/j.amjcard.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/07/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
Coronary artery perforation is one of the most common and feared complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We evaluated the utility of the recently presented OPEN-CLEAN (Coronary artery bypass graft, Length of occlusion, Ejection fraction, Age, calcificatioN) perforation score in an independent multicenter CTO PCI dataset. Of the 2,270 patients who underwent CTO PCI at 7 centers, 150 (6.6%) suffered coronary artery perforation. Patients with perforations were older (69 ± 10 vs 65 ± 10, p <0.001), more likely to be women (89% vs 82%, p = 0.010), more likely to have history of previous coronary artery bypass graft (38% vs 20%, p <0.001), and unfavorable angiographic characteristics such as blunt stump (64% vs 42%, p <0.001), proximal cap ambiguity (51% vs 33%, p <0.001), and moderate-severe calcification (57% vs 43%, p = 0.001). Technical success was lower in patients with perforations (69% vs 85%, p <0.001). The area under the receiver operating characteristic curve of the OPEN-CLEAN perforation risk model was 0.74 (95% confidence interval 0.68 to 0.79), with good calibration (Hosmer-Lemeshow p = 0.72). We found that the CTO PCI perforation risk increased with higher OPEN-CLEAN scores: 3.5% (score 0 to 1), 3.1% (score 2), 5.3% (score 3), 7.1% (score 4), 11.5% (score 5), 19.8% (score 6 to 7). In conclusion, given its good performance and ease of preprocedural calculation, the OPEN-CLEAN perforation score appears to be useful for quantifying the perforation risk for patients who underwent CTO PCI.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordoba, Spain
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordoba, Spain
| | - Stephane Rinfret
- Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Evangelia Vemmou
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Ilias Nikolakopoulos
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Joseph A Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | | | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-Nancy, France
| | - Karlyse C Belli
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Darshan Doshi
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Dmitrii Khelimskii
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Oleg Krestyaninov
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Pablo Lamelas
- Instituto Cardiovascularde Buenos Aires, Buenos Aires, Argentina
| | - Lucio Padilla
- Instituto Cardiovascularde Buenos Aires, Buenos Aires, Argentina
| | | | - James C Spratt
- St. George's University Healthcare NHS Trust, London, United Kingdom
| | - Masaki Tanabe
- Department of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
| | | | | | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Salman Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Taishi Hirai
- University of Missouri-Kansas City, Kansas City, Missouri
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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46
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Jonas RA, Crabtree TR, Jennings RS, Marques H, Katz RJ, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Al-Mallah MH, Guglielmo M, Bax JJ, Earls JP, Min JK, Choi AD, Villines TC. Diabetes, Atherosclerosis, and Stenosis by AI. Diabetes Care 2023; 46:416-424. [PMID: 36577120 PMCID: PMC9887618 DOI: 10.2337/dc21-1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Whether APCs differ based on lesion severity and diabetes status is unknown. RESEARCH DESIGN AND METHODS We retrospectively evaluated 303 subjects from the Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia (CREDENCE) trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (≥50% stenosed) or nonobstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs, including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low-density NCP (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP), and percentage of atheroma volume (PAV; PV normalized for vessel volume). The relationship between APCs, stenosis severity, and diabetes status was assessed. RESULTS Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the cohort with diabetes, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (P = 0.004). Patients with diabetes and nonobstructive disease had greater PV (P = 0.02), PAV (P = 0.02), NCP (P = 0.03), PAV NCP (P = 0.02), diseased vessels (P = 0.03), and maximum stenosis (P = 0.02) than patients without diabetes with nonobstructive disease. APCs were similar between patients with diabetes with nonobstructive disease and patients without diabetes with obstructive disease. Diabetes status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and nonobstructive lesions. CONCLUSIONS Patients with diabetes and nonobstructive stenosis had an association to similar APCs as patients without diabetes who had obstructive stenosis. Among patients with nonobstructive disease, patients with diabetes had more total PV and NCP.
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Affiliation(s)
- Rebecca A. Jonas
- Department of Internal Medicine, Thomas Jefferson University Medical Center; Philadelphia, PA
- Corresponding author: Rebecca A. Jonas,
| | | | | | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Richard J. Katz
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J. Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Kang Won National University Hospital, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women’s University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, AL
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | | | - Ryo Nakazato
- Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan
| | | | - Roel S. Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel J. Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | - James J. Jang
- Kaiser Permanente San Jose Medical Center, San Jose, CA
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, NV
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary’s Hospital, Athens, GA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, NJ
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus A. de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Marco Guglielmo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Amsterdam, the Netherlands
| | | | | | - Andrew D. Choi
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Todd C. Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA
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47
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Hoshino M, van de Hoef TP, Lee JM, Hamaya R, Kanaji Y, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia-Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Murai T, Nakayama M, Tanaka N, Shin ES, Sasano T, Appelman Y, Beijk M, Knaapen P, van Royen N, Escaned J, Koo BK, Piek JJ, Kakuta T. Abnormal physiological findings after FFR-based revascularisation deferral are associated with worse prognosis in women. Sci Rep 2023; 13:1027. [PMID: 36658168 PMCID: PMC9852478 DOI: 10.1038/s41598-023-28146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The prognostic value of abnormal resting Pd/Pa and coronary flow reserve (CFR) after fractional flow reserve (FFR)-guided revascularisation deferral according to sex remains unknown. From the ILIAS Registry composed of 20 hospitals globally from 7 countries, patients with deferred lesions following FFR assessment (FFR > 0.8) were included. (NCT04485234) The primary clinical endpoint was target vessel failure (TVF) at 2-years follow-up. We included 1392 patients with 1759 vessels (n = 564 women, 31.9%). Although resting Pd/Pa was similar between the sexes (p = 0.116), women had lower CFR than men (2.5 [2.0-3.2] vs. 2.7 [2.1-3.5]; p = 0.004). During a 2-year follow-up period, TVF events occurred in 56 vessels (3.2%). The risk of 2-year TVF was significantly higher in women with low versus high resting Pd/Pa (HR: 9.79; p < 0.001), whereas this trend was not seen in men. (Sex: P-value for interaction = 0.022) Furthermore, resting Pd/Pa provided an incremental prognostic value for 2-year TVF over CFR assessment only in women. After FFR-based revascularisation deferral, low resting Pd/Pa is associated with higher risk of TVF in women, but not in men. The predictive value of Pd/Pa increases when stratified according to CFR values, with significantly high TVF rates in women in whom both indices are concordantly abnormal.Clinical Trial Registration: Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.
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Affiliation(s)
- Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands.,Department of Cardiology, NoordWest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Division of Cardiovascular Health and Diseases, Veteran Affairs Medical Center, University of Cincinnati Medical Center, Cincinnati, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Tadashi Murai
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.,Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Marcel Beijk
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan.
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48
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Simsek B, Tajti P, Carlino M, Ojeda S, Pan M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Rempakos A, Dens JA, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Jaffer FA, Doshi D, Karmpaliotis D, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh S, Mastrodemos OC, Allana S, Rangan BV, Goktekin O, Gorgulu S, Poommipanit P, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, Azzalini L. External validation of the PROGRESS-CTO perforation risk score: Individual patient data pooled analysis of three registries. Catheter Cardiovasc Interv 2023; 101:326-332. [PMID: 36617391 DOI: 10.1002/ccd.30551] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Coronary artery perforation is one of the most feared and common complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS To assess the usefulness of the recently developed PROGRESS-CTO (NCT02061436) perforation risk score in independent cohorts. Individual patient-level data pooled analysis of three registries was performed. RESULTS Of the 4566 patients who underwent CTO PCI at 25 centers, 196 (4.2%) had coronary artery perforation. Patients with perforations were older (69 ± 10 vs. 65 ± 10, p < 0.001), more likely to be women (19% vs. 13%, p = 0.009), more likely to have a history of prior coronary artery bypass graft (34% vs. 20%, p < 0.001), and unfavorable angiographic characteristics such as blunt stump (62% vs. 48%, p < 0.001), proximal cap ambiguity (52% vs. 34%, p < 0.001), and moderate-severe calcification (60% vs. 49%, p = 0.002). Technical success was lower in patients with perforations (73% vs. 88%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO perforation risk model was 0.76 (95% confidence interval [CI], 0.72-0.79), with good calibration (Hosmer-Lemeshow p = 0.97). We found that the CTO PCI perforation risk increased with higher PROGRESS-CTO perforation scores: 0.3% (score 0), 2.3% (score 1), 3.1% (score 2), 5.5% (score 3), 7.5% (score 4), 14.6% (score 5). CONCLUSION Given the good discriminative performance, calibration, and the ease of calculation, the PROGRESS-CTO perforation score may facilitate assessment of the risk of perforation in patients undergoing CTO PCI.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Peter Tajti
- The Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Stephane Rinfret
- Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Evangelia Vemmou
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ilias Nikolakopoulos
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Joseph A Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | - Michael Megaly
- Division of Cardiology, Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-Nancy, Toulouse, France
| | - James W Choi
- Division of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Farouc A Jaffer
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Darshan Doshi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - James C Spratt
- St. George's University Healthcare NHS Trust, London, UK
| | - Masaki Tanabe
- Department of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
| | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Omer Goktekin
- Division of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Division of Cardiology, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Kathleen E Kearney
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Department for Internal Medicine and Cardiology, Heart center Lahr, Lahr, Germany
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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49
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Boerhout CKM, de Waard GA, Lee JM, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Chamuleau SAJ, van Royen N, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Combined use of hyperemic and non-hyperemic pressure ratios for revascularization decision-making: From the ILIAS registry. Int J Cardiol 2023; 370:105-111. [PMID: 36372287 DOI: 10.1016/j.ijcard.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the diagnostic and prognostic value of non-hyperaemic Pd/Pa and to determine its additional value when combined with the gold standard hyperaemic pressure ratio (FFR) to guide revascularization. METHODS In a large, multi-center, retrospective registry, we included a total of 2141 patients with a clinical indication for coronary angiography providing physiological data in 2726 vessels. A classification was made based on the FFR (cut-off value: 0.80) and non-hyperaemic Pd/Pa (cut-off value: 0.92) values and the primary outcome was target-vessel failure (TVF) at 5-year follow-up. RESULTS Mean age was 63 ± 10.0 and 75% of the study population were men. Regression analysis showed an overall good correlation between FFR and non-hyperaemic Pd/Pa (r = 0.73, p < 0.005) and discordance was present in 17% of the vessels. Resting Pd/Pa was independently associated with TVF at 5-year follow-up (HR 0.08, 95%CI: 0.02-0.27; p < 0.005). The risk for TVF was the lowest in vessles with concordant normal pressure ratio's, with the highest risk in vessels with any abnormal pressure ratio in which revascularization was deferred. In these vessels, there was no difference in risk for TVF between the discordant and concordant abnormal values. CONCLUSION Abnormal pressure ratios in both non-hyperemic and hyperemic conditions portend important prognostic value. Combined application of FFR and non-hyperemic Pd/Pa efficiently identifies those vessels with concordant normal resting and hyperemic pressure ratios of which long-term clinical outcomes are excellent. These data lead to hypothesize that the decision to defer revascularization should potentially be based on combined non-hyperemic and hyperemic pressure ratios. CLINICAL TRIAL REGISTRATION Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.
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Affiliation(s)
| | | | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
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50
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys PW. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EUROINTERVENTION 2022; 18:e872-e887. [PMID: 35994043 PMCID: PMC9743242 DOI: 10.4244/eij-e-22-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
- DASA, São Paulo, Brazil
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick W Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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