1
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Buchanan KD, Kolm P, Iantorno M, Gajanana D, Rogers T, Gai J, Torguson R, Ben-Dor I, Suddath WO, Satler LF, Waksman R. Coronary perfusion pressure and left ventricular hemodynamics as predictors of cardiovascular collapse following percutaneous coronary intervention. Cardiovascular Revascularization Medicine 2019; 20:11-15. [DOI: 10.1016/j.carrev.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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2
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Buchanan KD, Torguson R, Rogers T, Xu L, Gai J, Ben-Dor I, Suddath WO, Satler LF, Waksman R. In-Stent Restenosis of Drug-Eluting Stents Compared With a Matched Group of Patients With De Novo Coronary Artery Stenosis. Am J Cardiol 2018; 121:1512-1518. [PMID: 29627111 DOI: 10.1016/j.amjcard.2018.02.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
Drug-eluting stents (DES) significantly reduced the incidence of in-stent restenosis (ISR). However, ISR still exists in the contemporary DES era. Previously deemed to be a benign process, ISR leads to complex presentation and intervention. This study aimed to compare the presentation and outcome of DES-ISR versus de novo lesions. We performed a retrospective analysis of 11,666 patients receiving percutaneous coronary intervention from 2003 to 2017 and divided them into 2 groups by de novo stenosis and ISR. They were matched based on common cardiovascular risk factors at a 4:1 ratio, respectively. After matching, a total of 1,888 patients with 3,126 de novo lesions and 472 patients with 508 ISR lesions were analyzed. Patients with ISR presented more often with unstable angina (61% vs 45%, p <0.001) and less often with myocardial infarction (6% vs 14%, p <0.001). One-year composite major adverse cardiovascular event, defined as death, Q-wave myocardial infarction, and target vessel revascularization, was 10% in the de novo group and 17% in the ISR group (hazard ratio 1.98, 95% confidential interval 1.58 to 2.46, p <0.001). After adjusting for myocardial infarction presentation, hazard ratio of major adverse cardiovascular events was still higher for the ISR group at 1 year (2.03, 95% confidential interval 1.62 to 2.55, p <0.001). ISR of DES remains a therapeutic challenge and leads to complex presentation and worse outcomes compared with matched de novo patients. These data show that DES-ISR demands better appreciation and prevention with more precise stent technique and should motivate the continued development of fully bioresorbable scaffolds.
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Koifman E, Gaglia MA, Escarcega RO, Bernardo NL, Lager RA, Gallino RA, Ben-Dor I, Pichard AD, Baker NC, Lipinski MJ, Kiramijyan S, Negi SI, Torguson R, Gai J, Suddath WO, Satler LF, Waksman R. Comparison of transradial and transfemoral access in patients undergoing percutaneous coronary intervention for complex coronary lesions. Catheter Cardiovasc Interv 2016; 89:640-646. [DOI: 10.1002/ccd.26669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/10/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Michael A. Gaglia
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ricardo O. Escarcega
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Nelson L. Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Robert A. Lager
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Robert A. Gallino
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Augusto D. Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Nevin C. Baker
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Michael J. Lipinski
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Sarkis Kiramijyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Smita I. Negi
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - William O. Suddath
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
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Pendyala LK, Loh JP, Kitabata H, Minha S, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. The impact of diabetes mellitus on long-term clinical outcomes after percutaneous coronary saphenous vein graft interventions in the drug-eluting stent era. J Interv Cardiol 2016; 27:391-8. [PMID: 25059286 DOI: 10.1111/joic.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES We aimed to compare early and late clinical outcomes in diabetic and nondiabetic patients who underwent saphenous vein graft (SVG) percutaneous coronary interventions (PCI) with the use of drug-eluting stents (DES). BACKGROUND Patients with diabetes mellitus are shown to have less favorable outcomes after SVG intervention with the use of bare metal stents. In the DES era, the impact of diabetes mellitus on restenosis and clinical outcomes post-SVG intervention is not clearly defined. METHODS From our institutional PCI registry database, we retrospectively analyzed 477 consecutive patients with prior coronary artery bypass graft surgery undergoing SVG PCI with the implantation of DES stratified by the presence or absence of diabetes mellitus. The primary end-point was 1-year major adverse cardiac event (MACE) rate, defined as death, Q wave myocardial infarction, and target lesion revascularization. RESULTS Baseline clinical characteristics, including mean graft age (120 ± 77 vs. 131 ± 86 months, P = 0.14), were similar between groups, save for a higher prevalence of systemic hypertension and chronic renal insufficiency, and higher body mass index in the diabetic group. Among the 604 SVG lesions treated with DES, the angiographic and procedural characteristics were well matched between groups except for the higher rate of distal protection device use (32% vs. 29%, P = 0.007) in the diabetic group. The rates of 1-year MACE (21% vs. 15%, P = 0.12) and all-cause mortality (7.6% vs. 6.7%, P = 0.86) were similar between groups. After adjustment for the relevant clinical co-variables, diabetic status was not associated with the composite end-point. CONCLUSION In conclusion, DES, when used for the treatment of vein graft lesions, equate the short- and long-term outcomes between diabetic and nondiabetic patients, suggesting that DES should be considered the default stent in diabetic populations undergoing PCI for the treatment of SVG lesions.
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Affiliation(s)
- Lakshmana K Pendyala
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
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Gaglia MA, Torguson R, Lipinski MJ, Gai J, Koifman E, Kiramijyan S, Negi S, Rogers T, Steinvil A, Suddath WO, Satler LF, Pichard AD, Waksman R. Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type. Am J Cardiol 2016; 117:526-531. [PMID: 26739394 DOI: 10.1016/j.amjcard.2015.11.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
Although metallic coronary stents significantly reduce angina pectoris compared with optimal medical therapy, angina after percutaneous coronary intervention (PCI) remains frequent. We, therefore, sought to compare the incidence of any angina during the 1 year after PCI among the spectrum of commercially available metallic stents. Metallic stent type was classified as bare metal stent, Cypher, Taxus Express, Xience V, Promus Element, and Resolute. The primary end point was patient-reported angina within 1 year of PCI. Multivariable logistic regression was performed to assess the independent association of stent type with any angina at 1 year. Overall, 8,804 patients were queried in regard to angina symptoms; 32.3% experienced angina at some point in the first year after PCI. Major adverse cardiovascular events, a composite of all-cause mortality, target vessel revascularization, and Q-wave myocardial infarction, increased with angina severity: 6.8% for patients without angina, 10.0% for patients with class 1 or 2 angina, and 19.7% for patients with class 3 or 4 angina (p <0.001 for trend). After multivariable adjustment, there was no significant association between stent type and angina at 1 year after PCI. Baseline Canadian Cardiovascular Society class 3 or 4 angina, history of coronary artery bypass grafting, and history of PCI were associated with a higher likelihood of angina at 1 year; increasing age, male gender, presentation with acute coronary syndrome, and higher stented length were associated with less angina. In conclusion, metallic stent type is not associated with the occurrence of angina at up to 1 year after PCI.
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Gaglia MA, Lipinski MJ, Torguson R, Gai J, Ben-Dor I, Bernardo NL, Suddath WO, Satler LF, Pichard AD, Waksman R. CRT-200.31 Angina Following Percutaneous Coronary Intervention Is Common and Not Affected by Stent Type. JACC Cardiovasc Interv 2016. [DOI: 10.1016/j.jcin.2015.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee RC, Lipinski MJ, Tariq MU, Torguson R, Suddath WO, Waksman R. CRT-200.58 Acute MI With and Without Hemodynamic Support: A Network Meta-Analysis and Systematic Review. JACC Cardiovasc Interv 2016. [DOI: 10.1016/j.jcin.2015.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tian W, Mahmoudi M, Lhermusier T, Kiramijyan S, Chen F, Torguson R, Suddath WO, Satler LF, Pichard AD, Waksman R. The influence of advancing age on implantation of drug-eluting stents. Catheter Cardiovasc Interv 2015; 88:516-521. [DOI: 10.1002/ccd.26333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 10/26/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Wenjie Tian
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Michael Mahmoudi
- Section of Cardiovascular Sciences; University of Surrey, Guildford, Surrey; GU2-7XH United Kingdom
| | - Thibault Lhermusier
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Sarkis Kiramijyan
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Fang Chen
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - William O. Suddath
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Lowell F. Satler
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Augusto D. Pichard
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology; MedStar Washington Hospital Center; Washington, District of Columbia
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Negi SI, Didier R, Kang WY, Kiramijyan S, Koifman E, Gai J, Torguson R, Ben Dor I, Suddath WO, Pichard A, Satler LF, Waksman R. TCT-399 Long-Term Impact Of Iatrogenic Dissection Of A Left Main Coronary Artery During Percutaneous Coronary Intervention. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Magalhaes MA, Minha S, Torguson R, Baker NC, Escarcega RO, Omar AF, Lipinski MJ, Chen F, Suddath WO, Satler LF, Pichard AD, Waksman R. The effect of complete percutaneous revascularisation with and without intravascular ultrasound guidance in the drugeluting stent era. EUROINTERVENTION 2015; 11:625-33. [DOI: 10.4244/eijv11i6a124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Ota H, Magalhaes MA, Torguson R, Negi S, Kollmer MR, Spad MA, Gai J, Satler LF, Suddath WO, Pichard AD, Waksman R. The influence of lipid-containing plaque composition assessed by near-infrared spectroscopy on coronary lesion remodelling. Eur Heart J Cardiovasc Imaging 2015; 17:821-31. [DOI: 10.1093/ehjci/jev221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/10/2015] [Indexed: 11/12/2022] Open
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12
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Tian W, Mahmoudi M, Lhermusier T, Kiramijyan S, Ota H, Chen F, Torguson R, Suddath WO, Satler LF, Pichard AD, Waksman R. Comparison of Rotational Atherectomy, Plain Old Balloon Angioplasty, and Cutting-Balloon Angioplasty Prior to Drug-Eluting Stent Implantation for the Treatment of Heavily Calcified Coronary Lesions. J Invasive Cardiol 2015; 27:387-391. [PMID: 26332873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The optimal technique for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation has not been described. The aim of this study was to compare the clinical outcomes of lesion preparation with rotational atherectomy (ROTA), plain old balloon angioplasty (POBA), or cutting-balloon angioplasty (CBA) in patients with HCCL who were treated with DES. METHODS The study cohort comprised 737 consecutive patients (874 lesions) who underwent RA (n = 264), POBA (n = 220), or CBA (n = 253) for HCCL at our institution and were treated with DES. Patients with mild or moderate calcified lesions, restenotic lesions, treatment with bare-metal stent (BMS), or history of prior coronary artery bypass graft (CABG) were excluded. The analyzed clinical parameters were the 1-month, 6-month, and 12-month rates of death (all-cause and cardiac), Q-wave myocardial infarction (MI), target-lesion revascularization (TLR), definite stent thrombosis (ST), and major adverse cardiac event (MACE), defined as the composite of death, Q-wave MI, or TLR. RESULTS The patients were well matched for their baseline characteristics except for age (RA = 71.9 ± 10.4 years; POBA = 68.0 ± 10.8 years; CBA = 68.7 ± 11.8 years; P<.001) and hypertension (RA = 90.9%; POBA = 80.9%; CBA = 84.2%; P=.01), which were different among the three cohorts. The three cohorts had similar clinical outcomes at both short-term and long-term follow-up. The 12-month results were all-cause death (RA = 9.8%; POBA = 8.2%; CBA = 4.5%; P=.18), cardiac death (RA = 3.1%; POBA = 2.5%; CBA = 1.3%; P=.61), Q-wave MI (RA = 0%; POBA = 0%; CBA = 0.7%; P>.99), TLR (RA = 5.2%; POBA = 3.5%; CBA = 3.9%; P=.76), ST (RA = 0%; POBA = 0%; CBA = 0.6%; P=.63) and MACE (RA = 14.6%; POBA = 12.3%; CBA = 8.3%; P=.20). The 1-year MACE-free survival rates were also similar among the three cohorts (log-rank P=.20). CONCLUSION A strategy of lesion preparation with RA, POBA, or CBA in HCCL may be associated with similar clinical outcomes in patients undergoing percutaneous intervention with DES. The RA group had a trend toward greater MACE, death, and TLR.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Atherectomy, Coronary/adverse effects
- Atherectomy, Coronary/methods
- Calcinosis
- Coronary Artery Disease/diagnosis
- Coronary Artery Disease/etiology
- Coronary Artery Disease/surgery
- Coronary Restenosis/diagnosis
- Coronary Restenosis/surgery
- Drug-Eluting Stents/adverse effects
- Female
- Humans
- Intraoperative Care/methods
- Male
- Middle Aged
- Outcome Assessment, Health Care
- Plaque, Atherosclerotic/pathology
- Plaque, Atherosclerotic/surgery
- Retrospective Studies
- United States
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ron Waksman
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington DC 20010 USA.
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Magalhaes MA, Minha S, Chen F, Torguson R, Omar AF, Loh JP, Escarcega RO, Lipinski MJ, Baker NC, Kitabata H, Ota H, Suddath WO, Satler LF, Pichard AD, Waksman R. Response to letter regarding article, "Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations". Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.115.002459. [PMID: 25805572 DOI: 10.1161/circinterventions.115.002459] [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: 11/16/2022]
Affiliation(s)
- Marco A Magalhaes
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sa'ar Minha
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Fang Chen
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Al Fazir Omar
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Joshua P Loh
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ricardo O Escarcega
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Michael J Lipinski
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Nevin C Baker
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Hironori Kitabata
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Hideaki Ota
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - William O Suddath
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Department of Internal Medicine, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
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Ota H, Mahmoudi M, Kitabata H, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis. Cardiovascular Revascularization Medicine 2015; 16:84-9. [DOI: 10.1016/j.carrev.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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15
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Kiramijyan S, Magalhaes MA, Koifman E, Escarcega RO, Baker NC, Torguson R, Lipinski MJ, Ota H, Negi SI, Didier R, Lhermusier T, Kang WY, Tian W, Okubagzi P, Suddath WO, Ben-Dor I, Satler LF, Pichard AD, Waksman R. CRT-824 Does Angio-Seal Have a Role in Femoral Vascular Closure Following Transcatheter Aortic Valve Replacement? JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ota H, Magalhaes MA, Negi S, Didier R, Kang WY, Baker NC, Escarcega RO, Koifman E, Kiramijyan S, Torguson R, Kollmer MR, Satler LF, Suddath WO, Pichard AD, Waksman R. CRT-409 The Closed Association between Lipid-Containing Plaque Composition Measured by Near-Infrared Spectroscopy and Coronary Arterial Remodeling with Progression of Coronary Stenosis. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Ota H, Magalhaes MA, Negi S, Kang WY, Didier R, Baker NC, Escarcega RO, Koifman E, Kiramijyan S, Torguson R, Kollmer MR, Satler LF, Suddath WO, Pichard AD, Waksman R. CRT-410 Lipid-containing Plaque Distribution In Native Coronary Arteries: A Near-infrared Spectroscopy Study. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Kiramijyan S, Escarcega RO, Torguson R, Salmon JS, Kumar S, Weaver M, Spad MA, Sesaba KT, Koifman E, Magalhaes MA, Baker NC, Lipinski MJ, Negi SI, Hideaki O, Kang WY, Didier R, Jerusalem ZD, Okubagzi P, Ben-Dor I, Suddath WO, Satler LF, Pichard AD, Waksman R. CRT-810 Contemporary Outcomes of Patients Undergoing Balloon Aortic Valvuloplasty who were Initially Excluded from Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Negi SI, Didier R, Kiramijyan S, Koifman E, Baker N, Escarcega RO, Ben-Dor I, Suddath WO, Pichard AD, Satler LF, Waksman R. CRT-166 Gender Based Differences In Presentation And Outcomes Of Vascular Brachytherapy For Drug Eluting Stent Failure. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Escárcega RO, Baker NC, Magalhaes MA, Lipinski MJ, Minha S, Torguson R, Satler LF, Pichard AD, Suddath WO, Waksman R. Safety and efficacy of everolimus-eluting stents compared with first-generation drug-eluting stents in patients undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med 2014; 15:334-9. [PMID: 25440506 DOI: 10.1016/j.carrev.2014.08.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the safety and efficacy everolimus-eluting stents (EES) compared with first-generation drug-eluting stents (DES) in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND EES have been associated with improved clinical outcomes compared to paclitaxel-eluting stents (PES) and with similar outcomes compared to sirolimus-eluting stents (SES). METHODS A total of 520 patients who presented with ST-elevation myocardial infarction (STEMI) from 2003 to 2013, who underwent primary PCI with DES, were retrospectively analyzed. Of these, 247 received SES, 136 PES, and 137 EES. Patients were followed up to 2 years for major adverse cardiac events (MACE). Univariate and multivariate models detected correlates to outcome. RESULTS EES implantation, compared with PES and SES, resulted in comparable rates of MACE (8.8% vs. 16.2%, p=0.06 and 8.8% vs. 12.6%, respectively, p=0.26), stent thrombosis, MI, and target lesion revascularization. Patients who received EES had lower rates of all-cause mortality (3.7% vs. 12.6% vs. 9.4%, p=0.03) at 1-year follow up. However, in the univariate and multivariate analyses, stent type was not independently associated with the primary outcome or with all-cause mortality. Diabetes mellitus and number of stents implanted were independently associated with the primary outcome. CONCLUSION While EES seem to be associated with better outcome when compared to PES, the main correlates of STEMI patients are the presence of diabetes and number of stents implanted, and not the type of stent used for intervention.
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Affiliation(s)
- Ricardo O Escárcega
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Nevin C Baker
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Marco A Magalhaes
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Michael J Lipinski
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sa'ar Minha
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - William O Suddath
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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21
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Magalhaes MA, Minha S, Chen F, Torguson R, Omar AF, Loh JP, Escarcega RO, Lipinski MJ, Baker NC, Kitabata H, Ota H, Suddath WO, Satler LF, Pichard AD, Waksman R. Clinical Presentation and Outcomes of Coronary In-Stent Restenosis Across 3-Stent Generations. Circ Cardiovasc Interv 2014; 7:768-76. [DOI: 10.1161/circinterventions.114.001341] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Clinical presentation of bare metal stent in-stent restenosis (ISR) in patients undergoing target lesion revascularization is well characterized and negatively affects on outcomes, whereas the presentation and outcomes of first- and second-generation drug-eluting stents (DESs) remains under-reported.
Methods and Results—
The study included 909 patients (1077 ISR lesions) distributed as follows: bare metal stent (n=388), first-generation DES (n=425), and second-generation DES (n=96), categorized into acute coronary syndrome (ACS) or non-ACS presentation mode at the time of first target lesion revascularization. ACS was further classified as myocardial infarction (MI) and unstable angina. For bare metal stent, first-generation DES and second-generation DES, ACS was the clinical presentation in 67.8%, 71.0%, and 66.7% of patients, respectively (
P
=0.470), whereas MI occurred in 10.6%, 10.1%, and 5.2% of patients, respectively (
P
=0.273). The correlates for MI as ISR presentation were current smokers (odds ratio, 3.02; 95% confidence interval [CI], 1.78–5.13;
P
<0.001), and chronic renal failure (odds ratio, 2.73; 95% CI, 1.60–4.70;
P
<0.001), with a protective trend for the second-generation DES ISR (odds ratio, 0.35; 95% CI, 0.12–1.03;
P
=0.060). ACS presentations had an independent effect on major adverse cardiac events (death, MI, and re-target lesion revascularization) at 6 months (MI versus non-ACS: adjusted hazard ratio, 4.06; 95% CI, 1.84–8.94;
P
<0.001; unstable angina versus non-ACS: adjusted hazard ratio, 1.98; 95% CI, 1.01–3.87;
P
=0.046).
Conclusions—
ISR clinical presentation is similar irrespective of stent type. MI as ISR presentation seems to be associated with patient and not device-related factors. ACS as ISR presentation has an independent effect on major adverse cardiac events, suggesting that ISR remains a hazard and should be minimized.
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Affiliation(s)
- Marco A. Magalhaes
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Sa’ar Minha
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Fang Chen
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Rebecca Torguson
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Al Fazir Omar
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Joshua P. Loh
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Ricardo O. Escarcega
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Michael J. Lipinski
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Nevin C. Baker
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Hironori Kitabata
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Hideaki Ota
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - William O. Suddath
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Lowell F. Satler
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Augusto D. Pichard
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
| | - Ron Waksman
- From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC
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22
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Minha S, Loh JP, Satler LF, Pendyala LK, Barbash IM, Magalhaes MA, Suddath WO, Pichard AD, Torguson R, Waksman R. Transfer distance effect on reperfusion: timeline of ST-elevation patients transferred for primary percutaneous coronary intervention. Cardiovascular Revascularization Medicine 2014; 15:369-74. [DOI: 10.1016/j.carrev.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
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23
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Baker NC, Magalhaes MA, Escarcega RO, Minha S, Lipinski MJ, Lhermusier T, Pendyala L, Tian W, Ota H, Suddath WO, Satler LF, Pichard A, Torguson R, Waksman R. TCT-763 Clinical Profiles and Outcomes of Nonagenarians Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Lipinski MJ, Lhermusier T, Escarcega RO, Baker NC, Magalhães MA, Torguson R, Suddath WO, Satler LF, Pichard AD, Waksman R. Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials. Cardiovascular Revascularization Medicine 2014; 15:315-22. [DOI: 10.1016/j.carrev.2014.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022]
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25
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Baker NC, Lipinski MJ, Escarcega RO, Magalhaes MA, Minha S, Lhermusier T, Ota H, Pendyala L, Satler LF, Pichard A, Suddath WO, Torguson R, Waksman R. TCT-844 Active Versus Passive Anchoring Vascular Closure Devices: A Safety and Efficacy Comparative Analysis. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Magalhaes MA, Minha S, Escarcega RO, Lipinski MJ, Baker NC, Lhermusier T, Pendyala L, Ota H, Tian W, Deville M, Okubagzi P, Chen F, Torguson R, Suddath WO, Ben Dor I, Pichard A, Satler LF, Waksman R. TCT-104 Does Direct Stenting with Drug-eluting Stents Improve Outcome? A Systematic Review with Meta-Analysis of 10,513 Patients. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Ota H, Magalhaes MA, Pendyala L, Lhermusier T, Minha S, Baker NC, Escarcega RO, Tian W, Torguson R, Chen F, Satler LF, Suddath WO, Pichard A, Waksman R. TCT-659 Clinical Outcomes of Patients Presented with Sirolimus-eluting Stent Failure and Treated with Additional Drug-eluting Stent. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Baker NC, Escarcega RO, Lipinski MJ, Magalhaes MA, Minha S, Lhermusier T, Ota H, Pendyala L, Tian W, Pichard A, Satler LF, Suddath WO, Torguson R, Waksman R. TCT-4 Delayed Revascularization in High-Risk Non-ST Elevation Myocardial Infarction Patients Reflects a Clinical Decision not a Risk Score. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Omar A, Torguson R, Kitabata H, Pendyala LK, Loh JP, Magalhaes MA, Satler LF, Suddath WO, Pichard AD, Waksman R. Long-term safety and efficacy of second-generation everolimus-eluting stents compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome. Catheter Cardiovasc Interv 2014; 84:1053-60. [DOI: 10.1002/ccd.25469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Alfazir Omar
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Rebecca Torguson
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Hironori Kitabata
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | | | - Joshua P. Loh
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Marco A. Magalhaes
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Lowell F. Satler
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - William O. Suddath
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Augusto D. Pichard
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
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30
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Badr S, Minha S, Kitabata H, Fatemi O, Torguson R, Suddath WO, Satler LF, Pichard AD, Waksman R. Safety and long-term outcomes after percutaneous coronary intervention in patients with human immunodeficiency virus. Catheter Cardiovasc Interv 2014; 85:192-8. [DOI: 10.1002/ccd.25466] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/12/2014] [Accepted: 02/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Salem Badr
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Sa'ar Minha
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Hironori Kitabata
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Omid Fatemi
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - William O. Suddath
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Augusto D. Pichard
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
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31
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Maehara A, Mintz GS, Bui AB, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ. Intravascular ultrasound evidence of perivascular trauma during routine percutaneous coronary intervention. Int J Cardiovasc Imaging 2014; 30:849-56. [DOI: 10.1007/s10554-014-0413-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 03/28/2014] [Indexed: 12/22/2022]
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32
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Minha S, Magalhaes MA, Barbash IM, Ben-Dor I, Dvir D, Okubagzi PG, Chen F, Torguson R, Kent KM, Suddath WO, Satler LF, Pichard AD, Waksman R. Impact of previous coronary artery bypass grafting on patients undergoing transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol 2014; 113:1222-7. [PMID: 24513466 DOI: 10.1016/j.amjcard.2013.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Re-operation after coronary artery bypass grafting (CABG) is associated with increased risk for morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is an alternative for patients with aortic stenosis, but the outcomes of patients with a history of CABG are unknown. The aim of this study was to explore the association between previous CABG and the outcome of patients undergoing TAVI. Out of 372 consecutive patients who underwent TAVI from 2007 to 2013, 122 (32.8%) had previous CABG, whereas 250 (67.2%) did not. A comparison was made between groups. Subgroup analysis compared patients with and without previous CABG in 3 patient subsets: inoperable, operable, and those who underwent transapical TAVI. Patients with previous CABG were younger (81.99±6.78 vs 84.81±7.06 years, respectively, p<0.001). These patients also had more high-risk features (e.g., peripheral vascular disease, previous myocardial infarction, past cerebrovascular disease, and lower average left ventricular ejection fraction (p<0.05 for all). Procedural aspects were mostly similar between groups. No disparities in mortality rates at 1 year were noted (22.1% vs 21.6%, respectively, p=0.91). Subgroup analyses yielded similar outcomes for all 3 groups. In conclusion, although patients with previous CABG present with more high-risk features, they share similar short- and long-term outcomes with patients without previous CABG, irrespective of their surgical risk. This includes patients who underwent transapical access. TAVI in patients with previous CABG is safe and does not confer a significant risk for adverse outcome.
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33
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Loh JP, Satler LF, Pendyala LK, Minha S, Frohna WJ, Torguson R, Chen F, Suddath WO, Pichard AD, Waksman R. Use of emergency medical services expedites in-hospital care processes in patients presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med 2014; 15:219-25. [PMID: 24952684 DOI: 10.1016/j.carrev.2014.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 11/28/2022]
Abstract
To determine whether door-to-balloon (DTB) times of patients presenting with ST-elevation myocardial infarction (STEMI) were reduced in patients transported by emergency medical services (EMS) compared to those who were self-transported. DTB time is an important measure of hospital care processes in STEMI. Use of EMS may expedite in-hospital processing and reduce DTB times. A total of 309 consecutive STEMI patients who underwent primary percutaneous coronary intervention in our institution were analyzed. Excluded were patients who received fibrinolytics, presented in cardiac arrest, were intubated, or were transferred from another hospital. EMS-transported patients (n=83) were compared to self-transported patients (n=226). The primary outcome measure was DTB time and its component time intervals. Secondary end points included symptom-to-door and symptom-to-balloon times, and correlates for DTB >90 minutes. A higher percentage of EMS-transported patients reached the time goal of DTB <90 minutes compared to self-transported patients (83.1 versus 54.3%; p<0.001). EMS-transported patients had shorter DTB times [median (IQR) minutes, 65 (50-86) versus 85 (61-126); p<0.001] due to a reduction of emergency department processing (door-to-call) time, whereas catheterization laboratory processing (call-to-balloon) times were similar in both groups. EMS-transported patients had shorter symptom-to-door [median (IQR) hours, 1.2 (0.8-3.5) versus 2.3 (1.2-7.5); p<0.001] and symptom-to-balloon [median (IQR) hours, 2.5 (1.9-4.7) versus 4.3 (2.6-9.1); p<0.001]. Independent correlates of DTB times >90 minutes were self-transport (odds ratio 5.32, 95% CI 2.65-10.70; p<0.001) and off-hours presentation (odds ratio 2.89, 95% CI 1.60-5.22; p<0.001). Use of EMS transport in STEMI patients significantly shortens time to reperfusion, primarily by expediting emergency department processes. Community education efforts should focus not only on the importance of recognizing symptoms of myocardial infarction, but also taking early action by calling the EMS.
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Affiliation(s)
- Joshua P Loh
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | | | - Sa'ar Minha
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - William J Frohna
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Fang Chen
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - William O Suddath
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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34
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Baker N, Escarcega O, Lipinski M, Magalhaes M, Minha S, Loh J, Pendyala L, Omar AF, Ota H, Pichard A, Satler L, Suddath WO, Torguson R, Waksman R. CRT-114 Addition of Eptifibatide to Bivalirudin During St-Elevation Myocardial Infarction: Role for Combination Therapy? JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2014.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Minha S, Magalhaes M, Escarcega RO, Ben-Dor I, Baker N, Okubagzi P, Loh JP, Pendyala L, Omar AF, Ota H, Fang C, Torguson R, Satler LF, Suddath WO, Pichard A, Waksman R. CRT-704 What are the Correlates with Significant Post Transcatheter Aortic Valve Replacement Aortic Regurgitation? JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Magalhaes MA, Minha S, Escarcega RO, Baker NC, Lakshmana PK, Loh JP, Ota H, Omar AF, Rodriguez-Weisson JF, Torguson R, Okubagzi PG, Chen F, Suddath WO, Ben-Dor I, Satler LF, Pichard A, Waksman R. CRT-706 Humoral Response Following Transcatheter Aortic Valve Replacement Comparing Transapical and Transfemoral Approaches. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Magalhaes MA, Minha S, Rodriguez-Weisson JF, Escarcega RO, Baker NC, Okubagzi P, Torguson R, Chen F, Lakshmana P, Loh JP, Al Fazir O, Hideaki O, Wenjie T, Wang Z, Goldstein SA, Ben-Dor I, Suddath WO, Satler LF, Pichard AD, Waksman R. CRT-713 Usefulness of a Novel Index in Predicting the Permanent Pacemaker Necessity Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Magalhaes MA, Minha S, Escarcega RO, Baker NC, Lakshmana P, Al Fazir O, Loh JP, Hideaki O, Torguson R, Okubagzi P, Chen F, Ben-Dor I, Suddath WO, Satler LF, Pichard AD, Waksman R. CRT-714 Concomitant Mitral Regurgitation on Transcatheter Aortic Valve Replacement Patients: Is it a Surrogate or an Independent Predictor of Poor Outcome? JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Ota H, Magalhaes MA, Omar AF, Loh JP, Pendyala LK, Minha S, Baker N, Escarcega RO, Tian W, Torguson R, Chen F, Satler LF, Suddath WO, Pichard A, Waksman R. CRT-501 Does Additional Limus Stent Implantation Influences Outcomes Compared with Balloon Angioplasty for Sirolimus-Eluting In-Stent Restenosis? JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Lipinski MJ, Torguson R, Baker NC, Escarcega RO, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. CRT-127 Patients Characteristics and Clinical Implications of Switching Antiplatelet Therapy from Clopidogrel to Prasugrel or Ticagrelor. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2014.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Lipinski MJ, Pendyala L, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. CRT-134 Metformin Does Not Adversely Impact Outcome Following Percutaneous Coronary Intervention in Patients with Diabetes Mellitus. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2014.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Badr S, Kitabata H, Torguson R, Chen F, Suddath WO, Satler LF, Pichard AD, Waksman R, Bernardo NL. Incidence and correlates in the development of iatrogenic femoral pseudoaneurysm after percutaneous coronary interventions. J Interv Cardiol 2014; 27:212-6. [PMID: 24447166 DOI: 10.1111/joic.12091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to identify the correlates in the development of post-percutaneous coronary intervention (PCI) iatrogenic femoral pseudoaneurysm (IFP). BACKGROUND IFP is one of the more common vascular complications of PCI. METHODS From February 2008 to June 2012, 10,169 consecutive patients who underwent PCI were retrospectively studied. Patients who developed postprocedural IFP were identified at a single, large tertiary PCI center. RESULTS One hundred thirty-nine patients developed IFP (1.38%) and were compared to the cohort that did not. Baseline characteristics were comparable, although patients in the IFP group were older and had a higher incidence of insulin-requiring diabetes mellitus and chronic renal insufficiency (68.4 ± 12.9 vs. 65.4 ± 12.3 years, P = 0.004; 23.9% vs. 14.6%, P = 0.002; and 26.6% vs. 17.3%, P = 0.004, respectively). The non-IFP group had more men and a higher use of vascular closure devices, respectively (64.7% vs. 49.6%, P < 0.001; and 54.1% vs. 26.5%, P < 0.001). There was no significant difference in the use of dual antiplatelet or anticoagulation therapies between the 2 cohorts. Univariable correlates for the development of IFP were female gender, insulin-requiring diabetes mellitus, chronic renal insufficiency, and use of manual compression to achieve hemostasis. On multivariable analysis, the successful deployment of vascular closure device for hemostasis reduced the occurrence of IFP (odds ratio 0.31, 95% confidence interval 0.21-0.46, P < 0.0001). CONCLUSION The development of IFP following PCI is not uncommon and the appropriate use of vascular closure devices to achieve hemostasis should be encouraged to minimize this vascular complication.
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Affiliation(s)
- Salem Badr
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
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Kitabata H, Loh JP, Pendyala LK, Badr S, Dvir D, Barbash IM, Minha S, Torguson R, Chen F, Satler LF, Suddath WO, Kent KM, Pichard AD, Waksman R. Safety and efficacy outcomes of overlapping second-generation everolimus-eluting stents versus first-generation drug-eluting stents. Am J Cardiol 2013; 112:1093-8. [PMID: 23827397 DOI: 10.1016/j.amjcard.2013.05.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
The safety and efficacy outcomes of stent overlap with second-generation drug-eluting stents (DES) have not been well established. This study aimed to compare the 1-year clinical outcomes of overlapping everolimus-eluting stents (EES) with those of overlapping first-generation DES. This retrospective analysis included 350 patients treated with overlapping EES (169 patients with 237 lesions), sirolimus-eluting stents (SES, 102 patients with 252 lesions), or paclitaxel-eluting stents (PES, 79 patients with 182 lesions). End points were major adverse cardiovascular events (MACE: defined as the composite of death, myocardial infarction, or target lesion revascularization), target vessel revascularization, and definite stent thrombosis at 1 year. During a follow-up of 1 year, overall MACE occurred in 6.5% of EES-, 16.8% of SES-, and 10.1% of PES-treated patients (p = 0.026). Myocardial infarction was lowest in the EES group versus SES and PES groups (0 vs 1.0% vs 2.5%, respectively; p = 0.080), and mortality was similar (3.6% vs 9.0% vs 5.1%, p = 0.162). The EES patients showed a trend toward lower rates of 1-year target lesion revascularization (3.1% vs 8.2% vs 6.5%, p = 0.181) and target vessel revascularization (3.7% vs 9.1% vs 11.7%, p = 0.051) compared with the SES- and PES-treated patients. The cumulative incidence of definite stent thrombosis was lowest in the EES group (0 for EES vs 3.9% for SES vs 2.5% for PES, p = 0.014). In conclusion, stent overlap with EES versus first-generation DES was associated with lower rates of MACE and stent thrombosis. Our results suggest that the use of EES when deploying overlapping stents is effective and safe.
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Loh JP, Pendyala LK, Kitabata H, Badr S, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population. Int J Cardiol 2013; 170:43-8. [PMID: 24169532 DOI: 10.1016/j.ijcard.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/15/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features. METHODS The study included 5693 consecutive patients with the presence of ≥ 1 predefined complex clinical and angiographic characteristic treated with either generation DES. Using propensity score matching, the clinical outcomes of 1076 patients treated with 2nd-generation DES were compared with the outcomes of a matched population treated with 1st-generation DES over 1-year follow-up. RESULTS After matching, baseline clinical and angiographic characteristics were similar between groups. At 1-year follow-up, the rate of major adverse cardiac events was 9.4% with 2nd-generation DES and 11.3% with 1st-generation DES (p=0.16). There were no significant differences in the rates of death (3.2 vs. 4.0%, p=0.30), myocardial infarction (1.6 vs. 1.3%, p=0.57), target vessel revascularization (5.9 vs. 7.3%, p=0.17) or target lesion revascularization (4.4 vs. 5.0%, p=0.50). Definite stent thrombosis was less frequent with 2nd-generation DES (0.1 vs. 0.8%, p=0.011), as was definite or probable stent thrombosis (0.7 vs. 1.6%, p=0.040). CONCLUSION In this propensity score matched patient population with complex features undergoing percutaneous coronary intervention, the use of 2nd-generation DES was associated with lower rates of stent thrombosis, and similar 1-year major adverse cardiac events compared to 1st-generation DES.
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Affiliation(s)
- Joshua P Loh
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States
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Pendyala L, Badr S, Barbash I, Kitabata H, Loh JP, Minha S, Omar A, Ota H, Pichard A, Satler LF, Suddath WO, Torguson R, Waksman R. TCT-175 Does Diabetes Mellitus Impact Long-Term Clinical Outcomes After Percutaneous Coronary Saphenous Vein Graft Interventions In The Drug-Eluting Stent Era? J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Loh JP, Badr S, Barbash I, Chen F, Kent K, Kitabata H, Magalhaes MA, Minha S, Omar AF, Ota H, Pendyala L, Pichard A, Satler LF, Suddath WO, Torguson R, Waksman R. TCT-343 Does The National Cardiovascular Data Registry Bleeding Risk Score Accurately Predict Bleeding In African American Patients Undergoing Percutaneous Coronary Intervention? J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Magalhaes MA, Minha S, Badr S, Barbash I, Loh JP, Pendyala L, Kitabata H, Omar AF, Torguson R, Chen F, Kent K, Suddath WO, Satler LF, Pichard A, Waksman R. TCT-457 Is There A Difference In The Clinical Presentation Of Patients With In-Stent Restenosis Of First- Versus Second-Generation Drug-Eluting Stents? J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loh JP, Badr S, Barbash I, Chen F, Kent K, Kitabata H, Magalhaes MA, Minha S, Omar AF, Ota H, Pendyala L, Pichard A, Satler LF, Suddath WO, Torguson R, Waksman R. TCT-49 Comparison Of Stent Thrombosis Outcomes After Percutaneous Coronary Intervention Across Different Clinical Presentations. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Magalhaes MA, Minha S, Barbash I, Pendyala L, Loh JP, Kitabata H, Omar AF, Badr S, Ota H, Torguson R, Goldstein S, Wang Z, Chen F, Okubagzi P, Kent K, Suddath WO, Satler LF, Pichard A, Waksman R. TCT-740 Impact Of Post-Procedural Left Ventricular Geometric Patterns In Mortality After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Omar A, Kitabata H, Pendyala L, Magalhaes MA, Loh JP, Barbash I, Badr S, Minha S, Ota H, Chen F, Torguson R, Kent K, Pichard A, Satler LF, Suddath WO, Waksman R. TCT-185 Three-Year Safety And Efficacy Of Newer Generation Limus-Eluting Stents Compared To Bare Metal Stents and First-Generation Sirolimus-eluting Stents In Patients With Acute Coronary Syndrome. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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