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Bruno F, de Filippo O, Sardone A, Capranzano P, Conrotto F, Sheiban I, Giacobbe F, Laudani C, Burzotta F, Saia F, Escaned J, Raposeiras Roubin S, Mancone M, Templin C, Candreva A, Trabattoni D, Wanha W, Stefanini G, Chieffo A, Cortese B, Casella G, Wojakowski W, Colombo F, De Ferrari GM, Boccuzzi G, D'Ascenzo F, Iannaccone M. Long-term impact of intravascular ultrasound-guidance for percutaneous coronary intervention on unprotected left main. The IMPACTUS-LM, an observational, multicentric study. Int J Cardiol 2024; 401:131861. [PMID: 38365014 DOI: 10.1016/j.ijcard.2024.131861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The potential benefit on long term outcomes of Percutaneous Coronary Intervention (PCI) on Unprotected Left Main (ULM) driven by IntraVascular UltraSound (IVUS) remains to be defined. METHODS IMPACTUS LM-PCI is an observational, multicenter study that enrolled consecutive patients with ULM disease undergoing coronary angioplasty in 13 European high-volume centers from January 2002 to December 2015. Major Adverse Cardiovascular Events (MACEs) a composite of cardiovascular (CV) death, target vessel revascularization (TVR) and myocardial infarction (MI) were the primary endpoints, while its single components along with all cause death the secondary ones. RESULTS 627 patients with ULM disease were enrolled, 213 patients (34%) underwent IVUS-guided PCI while 414 (66%) angioguided PCI. Patients in the two cohorts had similar prevalence of risk factors except for active smoking and clinical presentation. During a median follow-up of 7.5 years, 47 (22%) patients in the IVUS group and 211 (51%) in the angio-guided group underwent the primary endpoint (HR 0.42; 95% CI [0.31-0.58] p < 0.001). After multivariate adjustment, IVUS was significantly associated with a reduced incidence of the primary endpoint (adj HR 0.39; 95% CI [0.23-0.64], p < 0.001), mainly driven by a reduction of TVR (ad HR 0.30, 95% CI [0.15-0.62], p = 0.001) and of all-cause death (adj HR 0.47, 95% CI [0.28-0.82], p = 0.008). IVUS use, age, diabetes, side branch stenosis, DES and creatinine at admission were independent predictors of MACE. CONCLUSIONS In patients undergoing ULM PCI, the use of IVUS was associated with a reduced risk at long-term follow-up of MACE, all-cause death and subsequent revascularization.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy..
| | - Ovidio de Filippo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Sardone
- San Giovanni Bosco Hospital, ASL Città Torino, Turin, Italy
| | - Piera Capranzano
- Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy
| | - Federico Conrotto
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Imad Sheiban
- Division of Cardiology, Peschiera del Garda Hospital, Verona, Italy
| | - Federico Giacobbe
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Claudio Laudani
- Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Universidad Complutense de Madrid, Calle del Prof Martín Lagos, 28040 Madrid, Spain
| | | | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | | | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
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Borzillo I, De Filippo O, Manai R, Bruno F, Ravetti E, Galanti AA, Vergallo R, Porto I, De Ferrari GM, D'Ascenzo F. Role of Intracoronary Imaging in Myocardial Infarction with Non-Obstructive Coronary Disease (MINOCA): A Review. J Clin Med 2023; 12:jcm12062129. [PMID: 36983131 PMCID: PMC10051698 DOI: 10.3390/jcm12062129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease occurs in 6% to 15% of all presentation of myocardial infarctions. The pathophysiologic mechanisms of MINOCA include epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, and coronary thrombus/embolism. The diagnosis is challenging, supported by intracoronary imaging with intravascular ultrasound (IVUS) and optical coherent tomography (OCT), coronary physiology testing, and cardiac magnetic resonance imaging (CMR). OCT is able to identify atherosclerotic causes of MINOCA (plaque erosion, plaque rupture, and calcified nodule) and nonatherosclerotic causes (spontaneous artery dissection, and spasm). In this review, we summarize the performance of the two intracoronary imaging modalities (IVUS and OCT) in MINOCA and discuss the importance of supplementing these modalities with CMR in order to drive target therapy.
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Affiliation(s)
- Irene Borzillo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
| | - Rossella Manai
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Alma Andrea Galanti
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Ultrathin Struts Drug-Eluting Stents: A State-of-the-Art Review. J Pers Med 2022; 12:jpm12091378. [PMID: 36143162 PMCID: PMC9503315 DOI: 10.3390/jpm12091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
New-generation drug-eluting stents (DESs) represent the standard of care for patients undergoing percutaneous coronary intervention (PCI). Recent iterations in DES technology have led to the development of newer stent platforms with a further reduction in strut thickness. This new DES class, known as ultrathin struts DESs, has struts thinner than 70 µm. The evidence base for these devices consists of observational data, large-scale meta-analyses, and randomized trials with long-term follow-up, which have been conducted to investigate the difference between ultrathin struts DESs and conventional new-generation DESs in a variety of clinical settings and lesion subsets. Ultrathin struts DESs may further improve the efficacy and safety profile of PCI by reducing the risk of target-lesion and target-vessel failures in comparison to new-generation DESs. In this article, we reviewed device characteristics and clinical data of the Orsiro (Biotronik, Bülach, Switzerland), Coroflex ISAR (B. Braun Melsungen, Germany), BioMime (Meril Life Sciences Pvt. Ltd., Gujarat, India), MiStent (MiCell Technologies, USA), and Supraflex (Sahajanand Medical Technologies, Surat, India) sirolimus-eluting stents.
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Prediction of All-Cause Mortality Following Percutaneous Coronary Intervention in Bifurcation Lesions Using Machine Learning Algorithms. J Pers Med 2022; 12:jpm12060990. [PMID: 35743777 PMCID: PMC9224705 DOI: 10.3390/jpm12060990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet clinical need that may be fulfilled through the adoption of machine learning (ML) algorithms to refine outcome predictions. We sought to develop an ML-based risk stratification model built on clinical, anatomical, and procedural features to predict all-cause mortality following contemporary bifurcation PCI. Multiple ML models to predict all-cause mortality were tested on a cohort of 2393 patients (training, n = 1795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real-world RAIN registry. Twenty-five commonly available patient-/lesion-related features were selected to train ML models. The best model was validated in an external cohort of 1701 patients undergoing bifurcation PCI from the DUTCH PEERS and BIO-RESORT trial cohorts. At ROC curves, the AUC for the prediction of 2-year mortality was 0.79 (0.74–0.83) in the overall population, 0.74 (0.62–0.85) at internal validation and 0.71 (0.62–0.79) at external validation. Performance at risk ranking analysis, k-center cross-validation, and continual learning confirmed the generalizability of the models, also available as an online interface. The RAIN-ML prediction model represents the first tool combining clinical, anatomical, and procedural features to predict all-cause mortality among patients undergoing contemporary bifurcation PCI with reliable performance.
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Gallone G, Kang J, Bruno F, Han JK, De Filippo O, Yang HM, Doronzo M, Park KW, Mittone G, Kang HJ, Parma R, Gwon HC, Cerrato E, Chun WJ, Smolka G, Hur SH, Helft G, Han SH, Muscoli S, Song YB, Figini F, Choi KH, Boccuzzi G, Hong SJ, Trabattoni D, Nam CW, Giammaria M, Kim HS, Conrotto F, Escaned J, Di Mario C, D'Ascenzo F, Koo BK, de Ferrari GM. Impact of Left Ventricular Ejection Fraction on Procedural and Long-Term Outcomes of Bifurcation Percutaneous Coronary Intervention. Am J Cardiol 2022; 172:18-25. [PMID: 35365291 DOI: 10.1016/j.amjcard.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 11/01/2022]
Abstract
The association of left ventricular ejection fraction (LVEF) with procedural and long-term outcomes after state-of-the-art percutaneous coronary intervention (PCI) of bifurcation lesions remains unsettled. A total of 5,333 patients who underwent contemporary coronary bifurcation PCI were included in the intercontinental retrospective combined insights from the unified RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) and COBIS (COronary BIfurcation Stenting) III bifurcation registries. Of 5,003 patients (93.8%) with known baseline LVEF, 244 (4.9%) had LVEF <40% (bifurcation with reduced ejection fraction [BIFrEF] group), 430 (8.6%) had LVEF 40% to 49% (bifurcation with mildly reduced ejection fraction [BIFmEF] group) and 4,329 (86.5%) had ejection fraction (EF) ≥50% (bifurcation with preserved ejection fraction [BIFpEF] group). The primary end point was the Kaplan-Meier estimate of major adverse cardiac events (MACEs) (a composite of all-cause death, myocardial infarction, and target vessel revascularization). Patients with BIFrEF had a more complex clinical profile and coronary anatomy. No difference in procedural (30 days) MACE was observed across EF categories, also after adjustment for in-study outcome predictors (BIFrEF vs BIFmEF: adjusted hazard ratio [adj-HR] 1.39, 95% confidence interval [CI] 0.37 to 5.21, p = 0.626; BIFrEF vs BIFpEF: adj-HR 1.11, 95% CI 0.25 to 2.87, p = 0.883; BIFmEF vs BIFpEF: adj-HR 0.81, 95% CI 0.29 to 2.27, p = 0.683). BIFrEF was independently associated with long-term MACE (median follow-up 21 months, interquartile range 10 to 21 months) than both BIFmEF (adj-HR 2.20, 95% CI 1.41 to 3.41, p <0.001) and BIFpEF (adj-HR 1.91, 95% CI 1.41 to 2.60, p <0.001) groups, although no difference was observed between BIFmEF and BIFpEF groups (adj-HR 0.87, 95% CI 0.61 to 1.24, p = 0.449). In conclusion, in patients who underwent PCI of a coronary bifurcation lesion according to contemporary clinical practice, reduced LVEF (<40%), although a strong predictor of long-term MACEs, does not affect procedural outcomes.
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De Filippo O, Kang J, Bruno F, Han JK, Saglietto A, Yang HM, Patti G, Park KW, Parma R, Kim HS, De Luca L, Gwon HC, Iannaccone M, Chun WJ, Smolka G, Hur SH, Cerrato E, Han SH, di Mario C, Song YB, Escaned J, Choi KH, Helft G, Doh JH, Truffa Giachet A, Hong SJ, Muscoli S, Nam CW, Gallone G, Capodanno D, Trabattoni D, Imori Y, Dusi V, Cortese B, Montefusco A, Conrotto F, Colonnelli I, Sheiban I, de Ferrari GM, Koo BK, D'Ascenzo F. Benefit of Extended Dual Antiplatelet Therapy Duration in Acute Coronary Syndrome Patients Treated with Drug Eluting Stents for Coronary Bifurcation Lesions (from the BIFURCAT Registry). Am J Cardiol 2021; 156:16-23. [PMID: 34353628 DOI: 10.1016/j.amjcard.2021.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022]
Abstract
Optimal dual antiplatelet therapy (DAPT) duration for patients undergoing percutaneous coronary intervention (PCI) for coronary bifurcations is an unmet issue. The BIFURCAT registry was obtained by merging two registries on coronary bifurcations. Three groups were compared in a two-by-two fashion: short-term DAPT (≤ 6 months), intermediate-term DAPT (6-12 months) and extended DAPT (>12 months). Major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization and stent thrombosis) were the primary endpoint. Single components of MACE were the secondary endpoints. Events were appraised according to the clinical presentation: chronic coronary syndrome (CCS) versus acute coronary syndrome (ACS). 5537 patients (3231 ACS, 2306 CCS) were included. After a median follow-up of 2.1 years (IQR 0.9-2.2), extended DAPT was associated with a lower incidence of MACE compared with intermediate-term DAPT (2.8% versus 3.4%, adjusted HR 0.23 [0.1-0.54], p <0.001), driven by a reduction of all-cause death in the ACS cohort. In the CCS cohort, an extended DAPT strategy was not associated with a reduced risk of MACE. In conclusion, among real-world patients receiving PCI for coronary bifurcation, an extended DAPT strategy was associated with a reduction of MACE in ACS but not in CCS patients.
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Affiliation(s)
- Ovidio De Filippo
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy.
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Francesco Bruno
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Andrea Saglietto
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della Carità, Novara, Novara, Italy
| | - Kyung-Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Radoslaw Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, Roma, Italy
| | - Hyeon-Cheol Gwon
- Department of Cardiology, Sungkyunkwan University Samsung Medical Center Seoul Republic of Korea
| | - Mario Iannaccone
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco,Torino, Italy
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Enrico Cerrato
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Seung Hwan Han
- Department of Internal Medicine, Division of Cardiology, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Young Bin Song
- Department of Cardiology, Sungkyunkwan University Samsung Medical Center Seoul Republic of Korea
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Ki Hong Choi
- Department of Cardiology, Sungkyunkwan University Samsung Medical Center Seoul Republic of Korea
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Joon-Hyung Doh
- Department of Internal Medicine, Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | | | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Saverio Muscoli
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Guglielmo Gallone
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
| | - Davide Capodanno
- Department of Cardio-Thoracic-Vascular , Division of Cardiology, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Bernardo Cortese
- Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Antonio Montefusco
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
| | - Federico Conrotto
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
| | | | | | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, University of Turin, Torino, Italy
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D'Ascenzo F, Elia E, Marengo G, Wańha W, González Ferreiro R, Truffa A, Trabattoni D, Figini F, Verardi R, Di Palma G, Infusino F, Pivato C, Ochała A, Omedè P, Milewski M, Estevez R, Raporeiras Roubin S, De Filippo O, Conrotto F, Montefusco A, Gili S, Cortese B, Dusi V, Gallone G, Manfredi R, Mancone M, Biondi Zoccai G, Casella G, Templin C, Stefanini G, Wojakowski W, Sheiban I, De Ferrari GM. Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY Registry). Am J Cardiol 2021; 156:72-78. [PMID: 34325877 DOI: 10.1016/j.amjcard.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
Long term survival and its determinants after Percutaneous Coronary Intervention (PCI) on Unprotected Left Main Coronary Artery (ULMCA) remain to be appraised. In 9 European Centers 470 consecutive patients performing PCI on ULMCA between 2002 and 2005 were retrospectively enrolled. Survival from all cause and cardiovascular (CV) death were the primary end points, while their predictors at multivariate analysis the secondary ones. Among the overall cohort 81.5% of patients were male and mean age was 66 ± 12 years. After 15 years (IQR 13 to 16), 223 patients (47%) died, 81 (17.2%) due to CV etiology. At multivariable analysis, older age (HR 1.06, 95%CI 1.02 to 1.11), LVEF < 35% (HR 2.97, 95%CI 1.24 to 7.15) and number of vessels treated during the index PCI (HR 1.75, 95%CI 1.12 to 2.72) were related to all-cause mortality, while only LVEF <35% (HR 4.71, 95%CI 1.90 to 11.66) to CV death. Repeated PCI on ULMCA occurred in 91 (28%) patients during the course of follow up and did not significantly impact on freedom from all-cause or CV mortality. In conclusion, in a large, unselected population treated with PCI on ULMCA, 47% died after 15 years, 17% due to CV causes. Age, number of vessels treated during index PCI and depressed LVEF increased risk of all cause death, while re-PCI on ULMCA did not impact survival.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy.
| | - Edoardo Elia
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Giorgio Marengo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Filippo Figini
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Roberto Verardi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy; U.O.C. Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - G Di Palma
- Cardiovascular Research Team, San Carlo Clinic, Milan, Italy
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Pivato
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Pierluigi Omedè
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Marek Milewski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roi Estevez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - O De Filippo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Antonio Montefusco
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | | | | | - Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Guglielmo Gallone
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Roberto Manfredi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - G Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; Mediterranea Cardiocentro, Naples, Italy
| | | | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Stefanini
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - G M De Ferrari
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
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8
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D’Ascenzo F, De Filippo O, Elia E, Doronzo MP, Omedè P, Montefusco A, Pennone M, Salizzoni S, Conrotto F, Gallone G, Angelini F, Franchin L, Bruno F, Boffini M, Gaudino M, Rinaldi M, De Ferrari GM. Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:476-485. [PMID: 32392283 PMCID: PMC8686114 DOI: 10.1093/ehjqcco/qcaa041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 08/30/2023]
Abstract
AIMS A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. METHODS AND RESULTS Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial's subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI 0.47-0.84 for values ≥ 33) while was not evident for 'younger' patients (OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older' patients). CONCLUSION For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score.
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Affiliation(s)
- Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Edoardo Elia
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Mattia Paolo Doronzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Cornell Medicine,
1300 York Ave, New York, NY 10065, USA
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
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9
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De Filippo O, Di Franco A, Boretto P, Bruno F, Cusenza V, Desalvo P, Demetres M, Saglietto A, Franchin L, Piroli F, Marengo G, Elia E, Falk V, Conrotto F, Doenst T, Rinaldi M, De Ferrari GM, D'Ascenzo F, Gaudino M. Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01238-1. [PMID: 34538641 DOI: 10.1016/j.jtcvs.2021.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparative data after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs distal) are scant. The aim of this meta-analysis was to investigate outcomes after PCI or CABG for ULMCA disease according to lesion site. METHODS Randomized controlled trials (RCTs) and adjusted observational studies that compared PCI versus CABG in patients with ULMCA disease and reported outcomes according to lesion site were systematically identified. Major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, stroke, and repeat revascularization) and all-cause death were the co-primary end points. Individual components of MACE were secondary end points. Sensitivity analysis including RCTs only were performed for each outcome. RESULTS Nine studies (3 RCTs, 6 adjusted observational), encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or distal ULMCA, respectively) were included. At the 5-year follow-up, there were no significant differences between CABG and PCI for MACE, death, or any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10 [95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95% CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The benefit of CABG for MACE and revascularization was confirmed in the analysis limited to RCTs, whereas the benefit for mortality was not. CONCLUSIONS Among patients with distal ULMCA disease, CABG is associated with lower incidence of MACE and revascularization compared with PCI, whereas no differences in outcomes were observed for ostial/shaft ULMCA disease.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Paolo Boretto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Vincenzo Cusenza
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Paolo Desalvo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences, Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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10
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Franchin L, Piroli F, D'Ascenzo F, Nuñez-Gil I, Wojakowski W, Imori Y, Trabattoni D, Huczek Z, Venuti G, Muscoli S, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Quadri G, Wańha W, Cortese B, De Filippo O, Ryan N, Varbella F, Sheiban I, Helft G, De Ferrari GM. Impact of stent thickness on clinical outcomes in small vessel and bifurcation lesions: a RAIN-CARDIOGROUP VII sub-study. J Cardiovasc Med (Hagerstown) 2021; 22:20-25. [PMID: 32740419 DOI: 10.2459/jcm.0000000000001037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The clinical impact of stent strut thickness in coronary bifurcation lesions in small vessels has not been assessed in a real-world population. METHODS All 506 patients enrolled in the RAIN study, undergoing PCI in a vessel with a diameter 2.5 mm or less were retrospectively evaluated and divided into two groups according to stent strut thickness: 74 μm (n = 206) versus 81 μm (n = 300); 87.1% of the lesions involved bifurcations. TLF [defined as a composite of myocardial infarction (MI) and target lesion revascularization (TLR)] was the primary endpoint, with MACE (a composite of death, MI and TLR), its components and stent thrombosis the secondary endpoint. RESULTS After 16 (14-18) months, a lower incidence of TLF (4.3 vs. 9.8%, P = 0.026) and ST (1.0 vs. 3.0%, P = 0.042) was seen in the 74 μm group, whereas MACE occurred in 60 of 506 patients, with no statistical difference between the two groups (9.7 vs. 13.3%, P = 0.070). At multivariate analysis, chronic renal failure increased the risk of TLF while thinner strut was an independent protective factor (hazard ratio 0.51, CI 0.17-0.85, P = 0.005). CONCLUSION In this real-world population, patients being treated for small vessels lesions with thinner strut stents had lower rates of TLF, MI and ST.
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Affiliation(s)
- Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Ivan Nuñez-Gil
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Cardio-thoracic-vascular Department, A.O.U. 'Vittorio Emanuele' Hospital, University of Catania, Catania
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome
| | | | - Andrea Rognoni
- Division of Cardiology, Maggiore della Carità Hospital, Novara
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Nicola Ryan
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | | | - Gerard Helft
- Sorbonne Université, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
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11
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Gallone G, D'Ascenzo F, Ielasi A, Landra F, Stefanini GG, Di Biasi M, Mancone M, Tomai F, Infantino V, Rognoni A, Briguori C, Boccuzzi G, Smolka G, Chiarito M, Capodanno D, Chieffo A, Fabbiocchi F, Poli A, Tespili M, D'Urbano M, Giordano A, Escaned J, De Ferrari GM, Sardella G. Polymer-free biolimus-eluting stents or polymer-based zotarolimus-eluting stents for coronary bifurcation lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:66-73. [PMID: 33903036 DOI: 10.1016/j.carrev.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A polymer-free biolimus-eluting stent (PF-BES) and a zotarolimus-eluting stent (ZES) recently showed similar clinical profiles and appear to be competing options in specific clinical settings of patients undergoing percutaneous coronary intervention (PCI). Whether they perform similarly also in complex procedural settings as coronary bifurcation lesions remains unaddressed. METHODS All consecutive patients undergoing coronary bifurcation PCI with PF-BES or the new iteration of the ZES from three large multicenter real-world registries were included. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST). Multiple analyses to adjust for baseline differences were carried out including propensity-score matching, propensity-score stratification and inverse-probability-weighting. Outcomes are reported according to Cox proportional hazard models censored at 400-day follow-up. RESULTS 1169 patients treated with PF-BES (n = 440) or ZES (n = 729) on the main branch of a coronary bifurcation lesion were included (mean age 69 ± 11 years, 75.4% male, 53.8% acute coronary syndrome at presentation, 26.6% left main bifurcation, median dual antiplatelet therapy duration 12 [range 12-12] months). MACE, all-cause death, TLR and ST tended towards non-statistically higher rates with the PF-BES as compared to the ZES. Higher MI and target vessel revascularization occurrence was observed with PF-BES. CONCLUSIONS In this large contemporary cohort of patients undergoing coronary bifurcation PCI, the occurrence of MACE was non-statistically different with the use of PF-BES and ZES devices. However, differences favoring the ZES device that may entail clinical relevance were observed. Further studies are needed to confirm these findings and explore whether they remain valid when a short dual antiplatelet therapy is adopted.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Alfonso Ielasi
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Federico Landra
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Massimo Mancone
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mauro Chiarito
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Fabbiocchi
- Interventional Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, Milan, Italy
| | - Arnaldo Poli
- Division of Cardiology, Ospedale di Legnano, ASST Milanese Ovest, Italy
| | - Maurizio Tespili
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Maurizio D'Urbano
- Division of Cardiology, Ospedale di Magenta, ASST Milanese Ovest, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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12
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Gallone G, D'Ascenzo F, Conrotto F, Costa F, Capodanno D, Muscoli S, Chieffo A, Yoichi I, Pennacchi M, Quadri G, Nuñez-Gil I, Bocchino PP, Piroli F, De Filippo O, Rolfo C, Wojakowski W, Trabattoni D, Huczek Z, Venuti G, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Boccuzzi G, Mattesini A, Cerrato E, Wańha W, Smolka G, Cortese B, Ryan N, Bo M, di Mario C, Varbella F, Burzotta F, Sheiban I, Escaned J, Helft G, De Ferrari GM. Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations. Catheter Cardiovasc Interv 2021; 97:E227-E236. [PMID: 32438488 DOI: 10.1002/ccd.28972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. METHODS The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. RESULTS After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI. CONCLUSIONS In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Imori Yoichi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mauro Pennacchi
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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13
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Rigatelli G, Zuin M. Occurence of left main occlusion on Tuesday: Chronobiology of acute myocardial infarction due to left main disease. J Saudi Heart Assoc 2020; 32:12-16. [PMID: 33154886 PMCID: PMC7640604 DOI: 10.37616/2212-5043.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives The existence of a “weekend effect” for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion. Methods We retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the day of admission, on the basis of the symptom onset time; the 30-day cardiovascular mortality was also analyzed on the basis of the time of symptom onset. Results Out of 1789 patients with AMI, 130 (7.2%, 104 males and 26 females, mean age 74.5 ± 8.1 years) had left main disease as the culprit lesion. Tuesday was significantly over-represented as the admission day (p < 0.001 for Tuesday vs. other days; p = 0.009 for Tuesday vs. Sunday, respectively). The 30-day cardiovascular survival was not different between patients admitted on Tuesday and those admitted on remaining days (Log-rank, Mantel Cox, p = 0.43; Chi-square = 0.611). A significant difference was noted in patients with AMI on Sunday versus remaining days (Log-rank, Mantel-Cox, p = 0.005; Chi-square = 7.96). The diameter of the left main artery was larger in patients admitted on Tuesdays than on Sundays (p < 0.01). Conclusion The relation between AMI onset and the day of the week is confirmed by our study, which also suggests that in case of a left main lesion, some delay of the weekend effect might be expected.
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Affiliation(s)
- Gianluca Rigatelli
- Cardioavascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
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14
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Gaido L, D’Ascenzo F, Imori Y, Wojakowski W, Saglietto A, Figini F, Mattesini A, Trabattoni D, Rognoni A, Tomassini F, Bernardi A, Ryan N, Muscoli S, Helft G, De Filippo O, Parma R, De Luca L, Ugo F, Cerrato E, Montefusco A, Pennacchi M, Wańha W, Smolka G, de Lio G, Bruno F, Huczek Z, Boccuzzi G, Cortese B, Capodanno D, Omedè P, Mancone M, Nuñez-Gil I, Romeo F, Varbella F, Rinaldi M, Escaned J, Conrotto F, Burzotta F, Chieffo A, Perl L, D’Amico M, di Mario C, Sheiban I, Gagnor A, Giammaria M, De Ferrari GM. Impact of Kissing Balloon in Patients Treated With Ultrathin Stents for Left Main Lesions and Bifurcations. Circ Cardiovasc Interv 2020; 13:e008325. [DOI: 10.1161/circinterventions.119.008325] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background:
There are limited data regarding the impact of final kissing balloon (FKI) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations.
Methods:
All patients undergoing left main or bifurcations percutaneous coronary intervention enrolled in the RAIN registry (Very Thin Stents for Patients With MAIN or BiF in Real Life: The RAIN, a Multicenter Study) evaluating ultrathin stents were included. Major adverse cardiac event (a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) was the primary end point, while its components, along with target vessel revascularization, were the secondary end points. The main analysis was performed comparing patients with and without FKI after adjustment with inverse probability of treatment weighting. Subgroup analyses were performed according to FKI (short [<3 mm] versus long overlap), strategy (provisional versus 2-stent), routine versus bail-out FKI, and the use of imaging and proximal optimization technique.
Results:
Two thousand seven hundred forty-two patients were included. At 16 months (8–20) follow-up, inverse probability of treatment weighting adjusted rates of major adverse cardiac event were similar between FKI and no-FKI group (15.1% versus 15.5%;
P
=0.967), this result did not change with use of imaging, proximal optimization technique, or routine versus bail-out FKI. In the 2-stent subgroup, FKI was associated with lower rates of target vessel revascularization (7.8% versus 15.9%;
P
=0.030) and target lesion revascularization (7.3% versus 15.2%;
P
=0.032). Short overlap FKI was associated with a lower rate of target lesion revascularization compared with no FKI (2.6% versus 5.4%;
P
=0.034), while long overlap was not (6.8% versus 5.4%;
P
=0.567).
Conclusions:
In patients with bifurcations or unprotected left main treated with ultrathin stents, short overlap FKI is associated with less restenosis. In a 2-stent strategy, FKI was associated with less target vessel revascularization and restenosis.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03544294.
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Affiliation(s)
- Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan (Y.I.)
| | - Wojciech Wojakowski
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Filippo Figini
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (A. Mattesini, C.d.M.)
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of Milan, Italy (D.T.)
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della Carità, Novara, Italy (A.R.)
| | - Francesco Tomassini
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Alessandro Bernardi
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Saverio Muscoli
- Department of Medicine, Università degli Studi di Roma ‘Tor Vergata’, Rome, Italy (S.M., F.R.)
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France (G.H.)
| | | | - Radoslaw Parma
- University Clinical Hospital, Warsaw, Poland (R.P., Z.H.)
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy (L.D.L., M.P.)
| | - Fabrizio Ugo
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Mauro Pennacchi
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy (L.D.L., M.P.)
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Giulia de Lio
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Zenon Huczek
- University Clinical Hospital, Warsaw, Poland (R.P., Z.H.)
| | - Giacomo Boccuzzi
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | | | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria “Policlinico-Vittorio Emanuele,” Catania, Italy (D.C.)
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Massimo Mancone
- Università degli Studi di ROMA “La Sapienza” (M.M.), Lazio, Italia
| | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma ‘Tor Vergata’, Rome, Italy (S.M., F.R.)
| | - Ferdiando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | | | | | - Leor Perl
- Rabin Medical Center, Department of Cardiology, Tel Aviv, Israel (L.P.)
| | - Maurizio D’Amico
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (A. Mattesini, C.d.M.)
| | - Imad Sheiban
- Pederzoli Hospital, Peschiera del Garda, Italy (I.S.)
| | - Andrea Gagnor
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Massimo Giammaria
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
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15
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Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: Latest Evidence. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:6. [PMID: 32034505 DOI: 10.1007/s11936-020-0806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional cardiologist in choosing the best, evidence-based technique, to treat commonly encountered coronary bifurcations. RECENT FINDINGS Current evidence supports the use of provisional stenting for most anatomically suitable bifurcation lesions. Newer techniques for side branch protection in provisional stenting have been developed. When a two-stent strategy is required, use of a double-kissing crush technique is favoured, particularly in left main bifurcations. For bifurcation PCI, as in all complex procedures, intravascular imaging plays a key adjunctive role in improving procedural success. PCI for coronary bifurcation lesions is an ever-growing field with significant advancements in techniques and technology.
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16
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Iannaccone M, D'Ascenzo F, Gallone G, Mitomo S, Parma R, Trabattoni D, Ryan N, Muscoli S, Venuti G, Montabone A, De Lio F, Zaccaro L, Quadri G, De Filippo O, Wojakowski W, Rognoni A, Helft G, Gallo D, De Luca L, Figini F, Imori Y, Conrotto F, Boccuzzi G, Mattesini A, Wańha W, Smolka G, Huczek Z, Rolfo C, Pennone M, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Morbiducci U, D'Amico M, Varbella F, Romeo F, Sheiban I, Escaned J, Garbo R, Moretti C, di Mario C, De Ferrari GM. Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes. Catheter Cardiovasc Interv 2019; 96:1-9. [PMID: 31860158 DOI: 10.1002/ccd.28667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/24/2019] [Accepted: 12/08/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. BACKGROUND Clinical impact of structural features of contemporary stents remains to be defined. METHODS All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum-chromium vs. cobalt-chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. RESULTS Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12-18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj-HR] 0.62, 95% confidence interval (CI) 0.39-0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32-0.93, p = .02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus-family eluted drug with outcomes was observed. CONCLUSIONS Among a range of contemporary very thin stent models, an increased number of connectors improved device-related outcomes in this investigated high-risk procedural setting.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, Savigliano, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Francesca De Lio
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Lorenzo Zaccaro
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Garbo
- Department of Cardiology, S.G. Bosco Hospital, Torino, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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17
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Pepe M, Biondi-Zoccai G, Corcione N, Nestola PL, Ferraro P, Morello A, Conte S, Prati F, Bianchi FP, Bortone AS, Giordano A. Comparative Effectiveness and Safety of Polymer-Free Biolimus-Eluting Stent and Durable Polymer Everolimus-Eluting Stent in All-Comer Patients Who Underwent Percutaneous Coronary Interventions. Am J Cardiol 2019; 124:195-204. [PMID: 31103132 DOI: 10.1016/j.amjcard.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/30/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
We aim to compare Polymer-Free Biolimus-Eluting Stent (PF-BES) with Durable Polymer Everolimus-Eluting stent (DP-EES) in unselected patients. PF-BES showed a favorable profile in high-bleeding risk patients who underwent percutaneous coronary intervention. Limited data are available on PF-BES compared with second-generation durable polymer-coated drug-eluting stents in patients eligible for standard dual antiplatelet therapy. A total of 848 consecutive patients were enrolled: 306 patients were treated with PF-BES and 542 with DP-EES. Stent performance was tested in a propensity score-matched population and in a Complex Higher-Risk and Indicated Patients (CHIP) subpopulation. A per-lesion analysis on 1,204 lesions (PF-BES = 424 vs DP-EES = 780) was also performed. At a medium follow-up of 18.5 ± 5.0 months, no differences in the matched population were found in terms of major adverse cardiac events (PF-BES 9.0% vs DP-EES 4.5%; p 0.091), myocardial infarction (PF-BES 6.2% vs DP-EES 2.3%; p 0.111), stent restenosis (PF-BES 2.3% vs DP-EES 0.0%; p 0.123), definite or probable stent thrombosis (PF-BES 2.8% vs DP-EES 1.1%; p 0.448). A significant inferior rate of restenosis was observed in the DP-EES arm in the whole (PF-BES 2.3% vs DP-EES 0.6%; p 0.041) and CHIP populations (PF-BES 4.3% vs DP-EES 0.5%; p 0.023), as well as in the per-lesion analysis (DP-EES 0.4% vs PF-BES 1.7%; p 0.039). In conclusion, in a real-world cohort PF-BES performed similarly to DP-EES in terms of restenosis and stent thrombosis in the matched population. Nonetheless, in the whole and CHIP populations, as well as in the per-lesion analysis, restenosis occurrence resulted higher in the PF-BES group.
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18
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De Filippo O, D'Ascenzo F, Piroli F, Budano C, De Ferrari GM. Sometimes neither water nor fire are more useful than friendship-a new risk score for prediction of contrast-induced nephropathy (CIN) and long-term adverse outcomes in patients undergoing coronary angiography. J Thorac Dis 2019; 11:2675-2679. [PMID: 31463091 DOI: 10.21037/jtd.2019.06.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
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