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Cortese B, Di Palma G, Guimaraes MG, Piraino D, Orrego PS, Buccheri D, Rivero F, Perotto A, Zambelli G, Alfonso F. Drug-Coated Balloon Versus Drug-Eluting Stent for Small Coronary Vessel Disease. JACC Cardiovasc Interv 2020; 13:2840-2849. [DOI: 10.1016/j.jcin.2020.08.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/28/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
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Rodríguez-Leor O, Cid-Álvarez B, Pérez de Prado A, Rossello X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Moreno R, Villa M, Ruíz-Salmerón R, Molano F, Sánchez C, Muñoz-García E, Íñigo L, Herrador J, Gómez-Menchero A, Gómez-Menchero A, Caballero J, Ojeda S, Cárdenas M, Gheorghe L, Oneto J, Morales F, Valencia F, Ruíz JR, Diarte JA, Avanzas P, Rondán J, Peral V, Pernasetti LV, Hernández J, Bosa F, Lorenzo PLM, Jiménez F, Hernández JMDLT, Jiménez-Mazuecos J, Lozano F, Moreu J, Novo E, Robles J, Moreiras JM, Fernández-Vázquez F, Amat-Santos IJ, Gómez-Hospital JA, García-Picart J, Blanco BGD, Regueiro A, Carrillo-Suárez X, Tizón H, Mohandes M, Casanova J, Agudelo-Montañez V, Muñoz JF, Franco J, Del Castillo R, Salinas P, Elizaga J, Sarnago F, Jiménez-Valero S, Rivero F, Oteo JF, Alegría-Barrero E, Sánchez-Recalde Á, Ruíz V, Pinar E, Pinar E, Planas A, Ledesma BL, Berenguer A, Fernández-Cisnal A, Aguar P, Pomar F, Jerez M, Torres F, García R, Frutos A, Nodar JMR, García K, Sáez R, Torres A, Tellería M, Sadaba M, Mínguez JRL, Merchán JCR, Portales J, Trillo R, Aldama G, Fernández S, Santás M, Pérez MPP. Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:994-1002. [PMID: 32917566 PMCID: PMC7834732 DOI: 10.1016/j.rec.2020.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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Xhepa E, Bresha J, Joner M, Rivero F, Nano N, Cuesta J, Ndrepepa G, Cassese S, Bastante Valiente T, Kufner S, Garcia-Guimaraes M, Perez-Vizcayno M, Gonzalo N, Alfonso F, Kastrati A. Influence of treatment modality and neointimal characteristics on optical coherence tomography on clinical outcomes of in-stent restenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In-stent restenosis (ISR) represents the more frequent modality of stent failure. The currently recommended treatment strategies are represented by repeat drug-eluting stent (DES) implantation or drug-coated balloon (DCB) angioplasty. Optical coherence tomography can display important information regarding mechanisms of stent failure as well as neointimal characterization.
Purpose
Aim of the present study was to determine the impact of treatment modality (DES vs. DCB) as well as neointimal characteristics (homogeneous vs. non-homogeneous) as determined by intravascular OCT, on clinical outcomes and explore whether there is an interaction between neointimal pattern of ISR and treatment modality.
Methods
Patients presenting with ischemic symptoms and/or evidence of myocardial ischemia in three European centers and undergoing intravascular OCT prior to percutaneous coronary intervention (PCI) for ISR, were retrospectively included in this study. Characterization of neointimal tissue was performed at the frame displaying the maximal %AS as well as the 5 preceding and following analyzed frames. Each frame was subdivided in 4 quadrants (90°) and the neointimal characteristics separately characterized for each of them. Based on its optical characteristics, neointimal tissue was categorized as homogeneous, heterogeneous, layered or neoatherosclerosis.
Based on the dominant neointimal type, the study population was divided in two groups, (predominantly homogeneous and non-homogeneous). Primary endpoints of the study were represented by major adverse cardiac events (MACE) and its idividual components (death, cardiac death, myocardial infarction and target lesion revascularization (TLR)) at 2 years follow-up.
Results
A total of 197 patients undergoing OCT prior to PCI for ISR were included in this study. 100 patients were classified as having predominantly homogeneous and 97 as having predominantly non-homogeneous neointima.
No association was found between predominant OCT pattern (homogenous vs. non-homogenous) and MACE at 2 years follow-up (HR=1.01, 95% CI: 0.59–1.75; p=0.94), or the individual MACE components. Analogously, no significant differences in terms of MACE at 2 years were found between predominantly homogeneous vs. non-homogeneous neointima in the patient subgroup receiving a DES (p=0.10) and in that undergoing DCB treatment (p=0.11).
However, a significant interaction was found between neointimal tissue pattern and treatment modality in terms of MACE (p=0.02) aa well as death or MI (p=0.016). Predominantly non-homogeneous neointima in patients treated with DCB was associated with a higher incidence of MACE.
Conclusions
Our results indicate that there is a significant interaction between treatment modality of ISR (DES vs. DCB) and neointimal pattern as determined by intravascular OCT. These results land initial support to an OCT-guided treatment of ISR and should be confirmed by larger trials.
Funding Acknowledgement
Type of funding source: None
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Amat-Santos I, Santos-Martinez S, Nombela-Franco L, Saia F, Muñoz-Garcia AJ, Gutiérrez E, Regueiro A, Jimenez Diaz VA, Rivero F, Romaguera R. TCT CONNECT-115 Transcatheter Aortic Valve Replacement for Residual Lesion After “Healed” Infective Endocarditis of the Aortic Valve—Feasibility and Safety Multicenter Study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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80
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Antuña P, Rivero F, Del Val D, Cuesta J, Alfonso F. Late Coronary Stent Thrombosis in a Patient With Coronavirus Disease 2019. JAMA Cardiol 2020; 5:1195-1198. [PMID: 32639522 DOI: 10.1001/jamacardio.2020.2459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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81
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Gutierrez-Barrios A, Rivero F, Lara JG, Izaga-Torralba E, Cañadas D, Silva E, Gheorghe LL, De Zayas Rueda R, Vázquez-García R, Perez GC, Alfonso F. TCT CONNECT-207 FFR Saline by Continuous Thermodilution Infusion. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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82
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Izaga-Torralba E, Gutierrez-Barrios A, Rivero F, Gheorghe LL, Lara JG, Silva E, Cañadas D, Rueda RDZ, Vázquez-García R, Perez GC, Alfonso F. TCT CONNECT-204 Volumetric Quantification of Absolute Coronary Flow to Assess Flow Reserve. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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83
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McInerney A, Tirado-Conte G, Rodés-Cabau J, Parada FC, Soto JT, Barbanti M, Muñoz-Garcia E, Arif M, Otero DL, Toggweiler S, Fernández GV, Pylko A, Sevilla T, Compagnone M, Regueiro A, Serra V, Manuel C, Oteo Dominguez JF, Rivero F, Ribeiro H, Guimarães L, Matta A, Echavarria NG, Valvo R, Moccetti F, Muñoz-Garcia AJ, Lopez-Pais J, Garcia-Del-Blanco B, Campanha Borges DC, Dumont E, Gonzalo N, Criscione E, Dabrowski M, Alfonso F, Hernandez JMDLT, Cheema A, Amat-Santos I, Saia F, Escaned J, Nombela-Franco L. TCT CONNECT-88 Impact of Morbid Obesity And Obesity Phenotype on Outcomes post Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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84
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Cortés C, Rivero F, Gutiérrez-Ibañes E, Aparisi Á, San Román JA, Amat-Santos IJ. Prospective validation and comparison of new indexes for the assessment of coronary stenosis: resting full-cycle and quantitative flow ratio. ACTA ACUST UNITED AC 2020; 74:94-97. [PMID: 32792309 DOI: 10.1016/j.rec.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023]
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85
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Antuña P, Cuesta J, Bastante T, Montes A, Rivero F, Alfonso F. Diagnosis of Intraplaque Hemorrhage by High-Definition Intravascular Ultrasound and Optical Coherence Tomography. JACC Cardiovasc Interv 2020; 13:1960-1962. [DOI: 10.1016/j.jcin.2020.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
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86
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Rivero F, Antuña P, Cuesta J, Alfonso F. Severe coronary spasm in a COVID-19 patient. Catheter Cardiovasc Interv 2020; 97:E670-E672. [PMID: 32738164 PMCID: PMC7436676 DOI: 10.1002/ccd.29056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022]
Abstract
Myocardial injury is frequently detected in coronavirus disease 2019 (COVID‐19) patients. However, up to one‐third of COVID‐19 patients showing ST‐segment elevation on the electrocardiogram have angiographically normal coronary arteries. We present a case of an acute coronary syndrome due to a coronary spasm in a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) patient. This pathophysiological mechanism was clearly demonstrated by intracoronary imaging techniques (optical coherence tomography) and invasive vasospasm test.
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Rodriguez-Gabella T, Catalá P, Muñoz-García AJ, Nombela-Franco L, Del Valle R, Gutiérrez E, Regueiro A, Jimenez-Diaz VA, Ribeiro HB, Rivero F, Fernandez-Diaz JA, Pibarot P, Alonso-Briales JH, Tirado-Conte G, Moris C, Diez Del Hoyo F, Jiménez-Britez G, Zaderenko N, Alfonso F, Gómez I, Carrasco-Moraleja M, Rodés-Cabau J, San Román Calvar JA, Amat-Santos IJ. Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 74:631-641. [PMID: 31370954 DOI: 10.1016/j.jacc.2019.05.055] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis. OBJECTIVES The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR). METHODS Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed. RESULTS A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions. CONCLUSIONS Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).
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Elgendy IY, Gad MM, Elgendy AY, Mahmoud A, Mahmoud AN, Cuesta J, Rivero F, Alfonso F. Clinical and Angiographic Outcomes With Drug-Coated Balloons for De Novo Coronary Lesions: A Meta-Analysis of Randomized Clinical Trials. J Am Heart Assoc 2020; 9:e016224. [PMID: 32410493 PMCID: PMC7660863 DOI: 10.1161/jaha.120.016224] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background The role of drug‐coated balloons (DCBs) in the treatment of de novo coronary lesions is not well established. Methods and Results Electronic databases and major conference proceedings were searched for randomized controlled trials that compared DCBs with stents or angioplasty for de novo coronary lesions. The primary outcome was target lesion revascularization. Summary estimates were conducted using random‐effects analysis complemented by several subgroup and sensitivity analyses. A total of 14 randomized controlled trials with 2483 patients were included. At a mean follow up of 12 months, DCBs were associated with no difference in the incidence of target lesion revascularization as compared with alternative strategies (risk ratio [RR], 0.79; 95% CI, 0.35–1.76). There was no difference in treatment effect based on the indication (ie, small‐vessel disease, myocardial infarction, bifurcation, or high bleeding risk) (Pinteraction=0.22). DCBs were associated with lower target lesion revascularization compared with bare metal stents and similar target lesion revascularization compared with drug‐eluting stents (Pinteraction=0.03). There was no difference between DCBs and control in terms of major adverse cardiac events, vessel thrombosis, or cardiovascular mortality. However, DCBs were associated with a lower incidence of myocardial infarction (RR, 0.48; 95% CI, 0.25–0.90) and all‐cause mortality (RR, 0.45; 95% CI, 0.22–0.94). Conclusions In patients with de novo coronary lesions, use of DCBs was associated with comparable clinical outcomes irrespective of the indication or comparator device. DCBs had a similar rate of target lesion revascularization compared with drug‐eluting stents. A randomized trial powered for clinical outcomes and evaluating the role of DCBs for all‐comers is warranted.
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García-Guimaraes M, Bastante T, Macaya F, Roura G, Sanz R, Barahona Alvarado JC, Tizón H, Flores-Ríos X, Moreu J, Ojeda S, Nogales JM, Veiga G, Masotti M, Camacho-Freire SJ, Jiménez-Valero S, Jiménez-Kockar M, Lozano Í, González-Ferreiro R, Velázquez M, Avanzas P, Rivero F, Alfonso F. Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events. ACTA ACUST UNITED AC 2020; 74:15-23. [PMID: 32418854 DOI: 10.1016/j.rec.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. METHODS We present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. RESULTS Between June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non-ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). CONCLUSIONS In Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events. Registered at ClnicalTrials.gov (Identifier: NCT03607981).
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Aguilera MC, Rivero F, Antuña P, Diego G, Rodríguez D, Alfonso F. Very Late Stent Thrombosis of a Titanium-Nitride-Oxide-Coated Bioactive Stent Resulting From Neoatherosclerosis: Optical Coherence Tomography Insights. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:119-120. [PMID: 32354581 DOI: 10.1016/j.carrev.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
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91
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Antuña P, Cuesta J, García-Guimaraes M, Bastante T, De Rueda C, Rivero F, Alfonso F. Treatment of In-Stent Restenosis. JACC Cardiovasc Interv 2020; 13:e53-e55. [DOI: 10.1016/j.jcin.2019.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022]
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Rivero F, Antuña P, García-Guimaraes M, Jiménez C, Cuesta J, Bastante T, Alfonso F. Correlation between fractional flow reserve and instantaneous wave-free ratio with morphometric assessment by optical coherence tomography in diabetic patients. Int J Cardiovasc Imaging 2020; 36:1193-1201. [PMID: 32221772 DOI: 10.1007/s10554-020-01819-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
Currently there is lack of data regarding the use of optical coherence tomography (OCT) to depict the hemodynamic relevance of coronary stenoses in diabetic patients. We sought to assess the diagnostic accuracy of OCT-derived morphologic assessment in identifying hemodynamically significant coronary lesions as determined by both, the resting instantaneous wave-free ratio (iFR) and the hyperemic fractional flow reserve (FFR) in diabetic patients. Diabetic patients presenting with at least one intermediate coronary lesion were prospectively and consecutively enrolled. All lesions were systematically assessed by iFR, FFR and OCT. A total of 41 intermediate lesions were analysed. Mean iFR and FFR values were 0.90 ± 0.04 and 0.81 ± 0.06, respectively (intra-class correlation coefficient 0.49; 95% CI 0.22-0.79). A moderate correlation between iFR and OCT derived minimal lumen diameter (MLD, r = 0.49) and minimal lumen area (MLA, r = 0.50) was found. Conversely, there was a poor correlation between FFR and OCT-derived MLD (r = 0.34) and MLA (r = 0.32). The diagnostic efficiency of MLA and MLD to identify iFR significant stenoses showed an AUC of 0.82 (95% CI 0.69-0.95) for MLD and 0.83 (95% CI 0.71-0.96) for MLA. A worse diagnostic efficiency was found when FFR was used as the reference with an AUC of 0.71 (95% CI 0.54-0.87) for MLD and 0.70 (95% CI 0.53-0.87). OCT-derived MLA and MLD were the strongest independent anatomic predictors of abnormal iFR and FFR values. In diabetic patients, OCT-derived MLA and MLD showed a moderate diagnostic efficiency in identifying functionally significant coronary stenoses by FFR or iFR. In diabetics, anatomic OCT measurements better predicted resting than FFR-determined physiologically significant lesions.
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Alfonso F, Rivero F, Granada JF. Safety of Paclitaxel-Coated Balloons in the Coronary Arteries. J Am Coll Cardiol 2020; 75:1029-1032. [DOI: 10.1016/j.jacc.2019.12.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 10/24/2022]
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Marin R, Lifante J, Besteiro LV, Wang Z, Govorov AO, Rivero F, Alfonso F, Sanz‐Rodríguez F, Jaque D. Plasmonic Copper Sulfide Nanoparticles Enable Dark Contrast in Optical Coherence Tomography. Adv Healthc Mater 2020; 9:e1901627. [PMID: 31977166 DOI: 10.1002/adhm.201901627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/20/2019] [Indexed: 12/29/2022]
Abstract
Optical coherence tomography (OCT) is an imaging technique affording noninvasive optical biopsies. Like for other imaging techniques, the use of dedicated contrast agents helps better discerning biological features of interest during the clinical practice. Although bright OCT contrast agents have been developed, no dark counterpart has been proposed yet. Herein, plasmonic copper sulfide nanoparticles as the first OCT dark contrast agents working in the second optical transparency window are reported. These nanoparticles virtually possess no light scattering capabilities at the OCT working wavelength (≈1300 nm); thus, they exclusively absorb the probing light, which in turn results in dark contrast. The small size of the nanoparticles and the absence of apparent cytotoxicity support the amenability of this system to biomedical applications. Importantly, in the pursuit of systems apt to yield OCT dark contrast, a library of copper sulfide nanoparticles featuring plasmonic resonances spanning the three optical transparency windows is prepared, thus highlighting the versatility and potential of these systems in light-controlled biomedical applications.
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Garcia-Guimaraes M, Antuña P, De la Cuerda F, Maruri-Sanchez R, Cuesta J, Bastante T, Rivero F, Alfonso F. High-Definition IVUS Versus OCT to Assess Coronary Artery Disease and Results of Stent Implantation. JACC Cardiovasc Imaging 2020; 13:519-521. [DOI: 10.1016/j.jcmg.2019.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/01/2022]
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Garcia-Guimarães M, Bastante T, Antuña P, Jimenez C, de la Cuerda F, Cuesta J, Rivero F, Premawardhana D, Adlam D, Alfonso F. Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management. Eur Cardiol 2020; 15:1-8. [PMID: 32256714 PMCID: PMC7113739 DOI: 10.15420/ecr.2019.01] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome that usually affects young to middle-aged women. Mainly because of its low prevalence, until recently, most of the evidence on this condition was derived from case reports and small series. Over the last 5 years, more robust evidence has become available from larger retrospective and prospective cohorts of patients with SCAD. The increase in knowledge and recognition of this entity has led to the publication of expert consensus on both sides of the Atlantic. However, new data are continuously accumulating from larger cohorts of patients with SCAD, bringing new light to this little-understood condition. The aim of this article is to update the knowledge on SCAD, including new information from recent studies published since the consensus documents from the European Society of Cardiology and the American Heart Association.
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Alfonso F, Rivero F. Superficial Calcific Sheets: A Novel Substrate for Acute Coronary Syndromes? JACC Cardiovasc Interv 2020; 12:541-544. [PMID: 30898250 DOI: 10.1016/j.jcin.2019.01.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 01/01/2023]
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98
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Gutiérrez-Barrios A, Rivero F, Noval-Morillas I, Gheorghe L, Calle-Pérez G, Alfonso F. Factibilidad de la cuantificación del flujo coronario absoluto y de la resistencia microvascular en la miocardiopatía de tako-tsubo. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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99
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Cuesta J, Antuña P, Jiménez C, Rivero F, Bastante T, García-Guimaraes M, Alfonso F. Can Plaque Erosion Be Visualized by High-Definition Intravascular Ultrasound? JACC Cardiovasc Interv 2019; 13:e57-e61. [PMID: 31883724 DOI: 10.1016/j.jcin.2019.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
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100
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Wijntjens GWM, van Uffelen EL, Echavarría-Pinto M, Casadonte L, Stegehuis VE, Murai T, Marques KMJ, Yoon MH, Tahk SJ, Casella G, Leone AM, López Palop R, Schlundt C, Rivero F, Petraco R, Fearon WF, Johnson NP, Jeremias A, Koo BK, Piek JJ, van de Hoef TP. Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With Intravenous Administration of Adenosine for Fractional Flow Reserve Assessment. Circ Cardiovasc Interv 2019; 13:e007893. [PMID: 31870178 DOI: 10.1161/circinterventions.119.007893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intravenous infusion of adenosine is considered standard practice for fractional flow reserve (FFR) assessment but is associated with adverse side-effects and is time-consuming. Intracoronary bolus injection of adenosine is better tolerated by patients, cheaper, and less time-consuming. However, current literature remains fragmented and modestly sized regarding the equivalence of intracoronary versus intravenous adenosine. We aim to investigate the relationship between intracoronary adenosine and intravenous adenosine to determine FFR. METHODS We performed a lesion-level meta-analysis to compare intracoronary adenosine with intravenous adenosine (140 µg/kg per minute) for FFR assessment. The search was conducted in accordance to the Preferred Reporting for Systematic Reviews and Meta-Analysis statement. Lesion-level data were obtained by contacting the respective authors or by digitization of scatterplots using custom-made software. Intracoronary adenosine dose was defined as; low: <40 µg, intermediate: 40 to 99 µg, and high: ≥100 µg. RESULTS We collected 1972 FFR measurements (1413 lesions) comparing intracoronary with intravenous adenosine from 16 studies. There was a strong correlation (correlation coefficient =0.915; P<0.001) between intracoronary-FFR and intravenous-FFR. Mean FFR was 0.81±0.11 for intracoronary adenosine and 0.81±0.11 for intravenous adenosine (P<0.001). We documented a nonclinically relevant mean difference of 0.006 (limits of agreement: -0.066 to 0.078) between the methods. When stratified by the intracoronary adenosine dose, mean differences between intracoronary and intravenous-FFR amounted to 0.004, 0.011, or 0.000 FFR units for low-dose, intermediate-dose, and high-dose intracoronary adenosine, respectively. CONCLUSIONS The present study documents clinically irrelevant differences in FFR values obtained with intracoronary versus intravenous adenosine. Intracoronary adenosine hence confers a practical and patient-friendly alternative for intravenous adenosine for FFR assessment.
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