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Sato T, Matsumura M, Yamamoto K, Shlofmitz E, Moses JW, Khalique OK, Shin D, Dakroub A, Singh M, Malik S, Tsoulios A, Cohen DJ, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Prevalence and anatomical factors associated with stent under-expansion in non-severely calcified lesions. Catheter Cardiovasc Interv 2024. [PMID: 38639137 DOI: 10.1002/ccd.31035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Stent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non-severely calcified lesions. AIM We sought to identify the prevalence and anatomical characteristics of underexpansion in non-severely calcified lesions. METHODS We included 993 patients who underwent optical coherence tomography-guided PCI of 1051 de novo lesions with maximum calcium arc <180°. Negative remodeling (NR) was the smallest lesion site external elastic lamina diameter that was also smaller than the distal reference. Stent expansion was evaluated using a linear regression model accounting for vessel tapering; underexpansion required both stent expansion <70% and stent area <4.5mm2. RESULTS Underexpansion was observed in 3.6% of non-heavily calcified lesions (38/1051). Pre-stent maximum calcium arc and thickness were greater in lesions with versus without underexpansion (median 119° vs. 85°, p = 0.002; median 0.95 mm vs. 0.78 mm, p = 0.008). NR was also more common in lesions with underexpansion (44.7% vs. 24.5%, p = 0.007). In the multivariable logistic regression model, larger and thicker eccentric calcium, mid left anterior descending artery (LAD) location, and NR were associated with underexpansion in non-severely calcified lesions. The rate of underexpansion was especially high (30.7%) in lesions exhibiting all three morphologies. Two-year TLF tended to be higher in underexpanded versus non-underexpanded stents (9.7% vs. 3.7%, unadjusted hazard ratio [95% confidence interval] = 3.02 [0.92, 9.58], p = 0.06). CONCLUSION Although underexpansion in the absence of severe calcium (<180°) is uncommon, mid-LAD lesions with NR and large and thick eccentric calcium were associated with underexpansion.
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Affiliation(s)
- Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Kei Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar K Khalique
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Doosup Shin
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ali Dakroub
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Mandeep Singh
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Sarah Malik
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Anna Tsoulios
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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Shlofmitz E, Garcia-Garcia HM, Chau K, Dakroub A, Thomas SV, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. Evaluation of the REDUCE-CLOT Study. JACC Cardiovasc Interv 2024:S1936-8798(24)00572-7. [PMID: 38639689 DOI: 10.1016/j.jcin.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
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Jeremias A, Maehara A, Matsumura M, Shlofmitz RA, Maksoud A, Akasaka T, Bezerra HG, Fearon WF, Samady H, Samuels B, Rapkin J, Gopinath A, Teraphongphom NT, Buccola J, Ali ZA. Optical Coherence Tomography-Based Functional Stenosis Assessment: FUSION-A Prospective Multicenter Trial. Circ Cardiovasc Interv 2024; 17:e013702. [PMID: 38525609 PMCID: PMC11008456 DOI: 10.1161/circinterventions.123.013702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Intravascular imaging and intracoronary physiology may both be used to guide and optimize percutaneous coronary intervention; however, they are rarely used together. The virtual flow reserve (VFR) is an optical coherence tomography (OCT)-based model of fractional flow reserve (FFR) facilitating the assessment of the physiological significance of coronary lesions. We aimed to validate the VFR assessment of intermediate coronary artery stenoses. METHODS FUSION (Validation of OCT-Based Functional Diagnosis of Coronary Stenosis) was a multicenter, prospective, observational study comparing OCT-derived VFR to invasive FFR. VFR was mathematically derived from a lumped parameter flow model based on 3-dimensional lumen morphology. Patients undergoing coronary angiography with intermediate angiographic stenosis (40%-90%) requiring physiological assessment were enrolled. Investigational sites were blinded to the VFR analysis, and all OCT and FFR data were reviewed by an independent core laboratory. The coprimary end points were the sensitivity and specificity of VFR against FFR as the reference standard, each of which was tested against prespecified performance goals. RESULTS After core laboratory review, 266 vessels in 224 patients from 25 US centers were included in the analysis. The mean angiographic diameter stenosis was 65.5%±14.9%, and the mean FFR was 0.83±0.11. Overall accuracy, sensitivity, and specificity of VFR versus FFR using a binary cutoff point of 0.80 were 82.0%, 80.4%, and 82.9%, respectively. The 97.5% lower confidence bound met the prespecified performance goal for sensitivity (71.6% versus 70%; P=0.01) and specificity (76.6% versus 75%; P=0.01). The area under the curve was 0.88 (95% CI, 0.84-0.92; P<0.0001). CONCLUSIONS OCT-derived VFR demonstrates high sensitivity and specificity for predicting invasive FFR. Integrating high-resolution intravascular imaging with imaging-derived physiology may provide synergistic benefits as an adjunct to percutaneous coronary intervention. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT04356027.
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Affiliation(s)
- Allen Jeremias
- St. Francis Hospital & Heart Center, Roslyn, NY (A.J., R.A.S., Z.A.A.)
- Cardiovascular Research Foundation, New York, NY (A.J., A.M., M.M., Z.A.A.)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY (A.J., A.M., M.M., Z.A.A.)
- Columbia University Medical Center, New York, NY (A.M.)
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, NY (A.J., A.M., M.M., Z.A.A.)
| | | | - Aziz Maksoud
- Cardiovascular Research Institute of Kansas, Wichita (A.M.)
| | | | - Hiram G. Bezerra
- Tampa General Hospital, University of South Florida, Tampa (H.G.B.)
| | | | - Habib Samady
- Northeast Georgia Medical Center, Gainesville (H.S.)
| | | | - Joshua Rapkin
- Abbott Vascular, Santa Clara, CA (J.R., A.G., N.T.T., J.B.)
| | - Ajay Gopinath
- Abbott Vascular, Santa Clara, CA (J.R., A.G., N.T.T., J.B.)
| | | | - Jana Buccola
- Abbott Vascular, Santa Clara, CA (J.R., A.G., N.T.T., J.B.)
| | - Ziad A. Ali
- St. Francis Hospital & Heart Center, Roslyn, NY (A.J., R.A.S., Z.A.A.)
- Cardiovascular Research Foundation, New York, NY (A.J., A.M., M.M., Z.A.A.)
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Jeremias A. Coronary Physiology to Optimize Percutaneous Coronary Intervention. Cardiol Clin 2024; 42:xi-xii. [PMID: 37949543 DOI: 10.1016/j.ccl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Allen Jeremias
- Cardiac Catheterization Laboratory, St. Francis Hospital & Heart Center, 100 Port Washington Boulevard, Suite #105, Roslyn, NY 11576, USA.
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Beatty B, Shin D, Wolff E, Shearer M, Saggio G, Shlofmitz E, Jeremias A, Moses JW, Shlofmitz RA, Ali ZA. Quantitative In Vitro Investigation of Polymer Damage on Drug-Eluting Stents Resulting From Intravascular Lithotripsy. JACC Cardiovasc Interv 2024; 17:320-322. [PMID: 37902153 DOI: 10.1016/j.jcin.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
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Sharma SK, Mehran R, Vogel B, Hooda A, Sartori S, Hanstein R, Feng Y, Shlofmitz RA, Jeremias A, Spirito A, Cao D, Shlofmitz E, Ali ZA, Yasumura K, Minatoguchi S, Vengrenyuk Y, Kini A, Moses JW. Rotational atherectomy combined with cutting balloon to optimise stent expansion in calcified lesions: the ROTA-CUT randomised trial. EUROINTERVENTION 2024; 20:75-84. [PMID: 38165112 PMCID: PMC10756220 DOI: 10.4244/eij-d-23-00811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of calcified lesions remains challenging for interventionalists. AIMS We aimed to investigate whether combining rotational atherectomy (RA) with cutting balloon angioplasty (RA+CBA) results in more optimal stent expansion compared with RA followed by non-compliant balloon angioplasty (RA+NCBA). METHODS ROTA-CUT is a prospective, multicentre, randomised trial of 60 patients with coronary artery disease undergoing PCI of moderately or severely calcified lesions with drug-eluting stent implantation. Patients were randomised 1:1 to either RA+CBA or RA+NCBA. The primary endpoint was the minimum stent area on intravascular ultrasound (IVUS). Secondary endpoints included minimum lumen area and stent expansion assessed by IVUS and acute lumen gain, final residual diameter stenosis and minimum lumen diameter assessed by angiography. Clinical endpoints were obtained at 30 days. RESULTS The mean age was 71.1±9.4 years, and 22% were women. The procedural details of RA were similar between groups, as were procedure duration and contrast use. Minimum stent area was similar with RA+CBA versus RA+NCBA (6.7±1.7 mm2 vs 6.9±1.8 mm2; p=0.685). Furthermore, there were no significant differences regarding the other IVUS and angiographic endpoints. Procedural complications were rare, and 30-day clinical events included 2 myocardial infarctions and 1 target vessel revascularisation in the RA+CBA group and 1 myocardial infarction in the RA+NCBA group. CONCLUSIONS Combining RA with CBA resulted in a similar minimum stent area compared with RA followed by NCBA in patients undergoing PCI of moderately or severely calcified lesions. RA followed by CBA was safe with rare procedural complications and few clinical adverse events at 30 days.
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Affiliation(s)
- Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Regina Hanstein
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yihan Feng
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ziad A Ali
- St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | | | - Shingo Minatoguchi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuliya Vengrenyuk
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Matsumura M, Maehara A, Davis JE, Kumar G, Sharp A, Samady H, Seto AH, Cohen D, Patel MR, Ali ZA, Stone GW, Jeremias A. Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy. EUROINTERVENTION 2023; 19:e903-e912. [PMID: 38031488 PMCID: PMC10719742 DOI: 10.4244/eij-d-23-00517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Justin E Davis
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Andrew Sharp
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | | | - David Cohen
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
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Samuels BA, Shah SM, Widmer RJ, Kobayashi Y, Miner SES, Taqueti VR, Jeremias A, Albadri A, Blair JA, Kearney KE, Wei J, Park K, Barseghian El-Farra A, Holoshitz N, Janaszek KB, Kesarwani M, Lerman A, Prasad M, Quesada O, Reynolds HR, Savage MP, Smilowitz NR, Sutton NR, Sweeny JM, Toleva O, Henry TD, Moses JW, Fearon WF, Tremmel JA. Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1245-1263. [PMID: 37704315 DOI: 10.1016/j.jacc.2023.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
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Affiliation(s)
- Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - R Jay Widmer
- Baylor Scott and White Health, Temple, Texas, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen Jeremias
- St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | | | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Megha Prasad
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
| | - Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Jeffery W Moses
- St Francis Hospital and Heart Center, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Smilowitz NR, Prasad M, Widmer RJ, Toleva O, Quesada O, Sutton NR, Lerman A, Reynolds HR, Kesarwani M, Savage MP, Sweeny JM, Janaszek KB, Barseghian El-Farra A, Holoshitz N, Park K, Albadri A, Blair JA, Jeremias A, Kearney KE, Kobayashi Y, Miner SES, Samuels BA, Shah SM, Taqueti VR, Wei J, Fearon WF, Moses JW, Henry TD, Tremmel JA. Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1264-1279. [PMID: 37704316 DOI: 10.1016/j.jacc.2023.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Megha Prasad
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | | | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jeffery W Moses
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA; St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
| | - Jennifer A Tremmel
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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10
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Escaned J, Berry C, De Bruyne B, Shabbir A, Collet C, Lee JM, Appelman Y, Barbato E, Biscaglia S, Buszman PP, Campo G, Chieffo A, Colleran R, Collison D, Davies J, Giacoppo D, Holm NR, Jeremias A, Paradies V, Piróth Z, Raposo L, Roguin A, Rudolph T, Sarno G, Sen S, Toth GG, Van Belle E, Zimmermann FM, Dudek D, Stefanini G, Tarantini G. Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology. EUROINTERVENTION 2023; 19:464-481. [PMID: 37171503 PMCID: PMC10436072 DOI: 10.4244/eij-d-23-00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yolande Appelman
- Amsterdam UMC, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Piotr P Buszman
- Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- American Heart of Poland, Ustroń, Poland
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Róisín Colleran
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Justin Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Daniele Giacoppo
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
- ISAResearch, German Heart Centre Munich, Munich, Germany
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Luís Raposo
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Giovanna Sarno
- Cardiology, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Lille, France
- Department of Cardiology, Institut Pasteur de Lille, Lille, France
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- University of Padua Medical School, Padua, Italy
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11
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Sato T, Yamamoto K, Matsumura M, Shlofmitz E, Khalique OK, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Discrimination of Calcified Nodule as a Cause of Coronary Angiographic Radiolucent Mass. JACC Cardiovasc Interv 2023; 16:1948-1949. [PMID: 37409997 DOI: 10.1016/j.jcin.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023]
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12
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Chau KW, Dakroub A, Shlofmitz ES, Shlofmitz RA, Jeremias A, Ali ZA. Recurrence of Protruding Calcified Nodule Visualized Using Optical Coherence Tomography Following Stent Implantation. JACC Cardiovasc Interv 2023; 16:1807-1808. [PMID: 37495354 DOI: 10.1016/j.jcin.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Karen W Chau
- St Francis Hospital, Roslyn, New York, USA; New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | | | | | | | | | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
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13
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Cao JJ, Shen L, Nguyen J, Rapelje K, Porter C, Shlofmitz E, Jeremias A, Cohen DJ, Ali ZA, Shlofmitz R. Accuracy and limitation of plaque detection by coronary CTA: a section-to-section comparison with optical coherence tomography. Sci Rep 2023; 13:11845. [PMID: 37481671 PMCID: PMC10363114 DOI: 10.1038/s41598-023-38675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
Plaques identified by Coronary CT angiography (CCTA) are important in clinical diagnosis and primary prevention. High-risk plaque features by CCTA have been extensively validated using optical coherence tomography (OCT). However, since their general diagnostic performance and limitations have not been fully investigated, we sought to compare CCTA with OCT among consecutive vessel sections. We retrospectively compared 188 consecutive plaques and 84 normal sections in 41 vessels from 40 consecutive patients referred for chest pain evaluation who had both CCTA and OCT with a median time lapse of 1 day. The distance to reference points were used to co-register between the modalities and the diagnostic performance of CCTA was evaluated against OCT. Plaque categories evaluated by CT were calcified, non-calcified and mixed. The diagnostic performance of CCTA was excellent for detecting any plaque identified by OCT with the sensitivity, specificity, negative and positive predictive values and accuracy of 92%, 98%, 99%, 84% and 93%, respectively. The lower than expected negative predictive value was due to failure of detecting sub-millimeter calcified (≤ 0.25 mm2) (N = 12) and non-calcified plaques (N = 4). Misclassification of plaque type accounted for majority of false negative findings (25/41, 61%) which was most prevalent among the mixed plaque (19/41, 46%). There was calcification within mixed plaques (N = 5) seen by CCTA but missed by OCT. Our findings suggest that CCTA is excellent at identifying coronary plaques except those sub-millimeter in size which likely represent very early atherosclerosis, although the clinical implication of very mild atherosclerosis is yet to be determined.
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Affiliation(s)
- J Jane Cao
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA.
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - James Nguyen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Kathleen Rapelje
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Craig Porter
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - David J Cohen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
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14
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Karimi Galougahi K, Dakroub A, Chau K, Mathew R, Mullasari A, Singh B, Sengottuvelu G, Maehara A, Mintz G, Jeremias A, Shlofmitz E, West NEJ, Shlofmitz R, Ali ZA. Utility of optical coherence tomography in acute coronary syndromes. Catheter Cardiovasc Interv 2023. [PMID: 37245076 DOI: 10.1002/ccd.30656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/29/2023]
Abstract
Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologies. The purpose of this review is to summarize the data from clinical studies that have used high-resolution intravascular optical coherence tomography (OCT) to assess culprit plaque morphology in ACS. In addition, we discuss the utility of intravascular OCT for effective treatment of patients presenting with ACS, including the possibility of culprit lesion-based treatment by percutaneous coronary intervention.
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Affiliation(s)
| | | | - Karen Chau
- St Francis Hospital, Roslyn, New York, USA
| | | | - Ajit Mullasari
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | | | - Akiko Maehara
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | | | | | | | - Richard Shlofmitz
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
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15
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Sato T, Matsumura M, Yamamoto K, Shlofmitz E, Moses JW, Khalique OK, Thomas SV, Tsoulios A, Cohen DJ, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Impact of Eruptive vs Noneruptive Calcified Nodule Morphology on Acute and Long-Term Outcomes After Stenting. JACC Cardiovasc Interv 2023; 16:1024-1035. [PMID: 37164599 DOI: 10.1016/j.jcin.2023.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Whether an eruptive or noneruptive target lesion calcified nodule (CN) portends worse acute and long-term clinical outcomes after stenting has not been established. OBJECTIVES The authors sought to compare acute and long-term clinical outcomes in eruptive CN vs noneruptive CN morphology. METHODS Using optical coherence tomography, an eruptive CN was defined as an accumulation of small calcium fragments protruding and disrupting the overlying fibrous cap, typically with small amount of thrombus. A noneruptive CN was defined as an accumulation of small calcium fragments with a smooth intact fibrous cap without an overlying thrombus. The primary endpoint was target lesion failure (TLF) including cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization in patients with ≥6-month follow-up. RESULTS Among 3,231 patients with evaluable pre- and postintervention OCT, 236 patients had lesions with CNs (7.3%). After eliminating 4 secondary lesions and 6 patients without ≥6-month follow-up, 126 (54.8%) lesions with eruptive CNs and 104 (45.2%) lesions with noneruptive CNs formed the current report. Compared with noneruptive CNs, eruptive CNs were independently associated with greater stent expansion (89.2% ± 18.7% vs. 81.5% ± 18.9%; P = 0.003) after adjusting for morphologic and procedural factors. At 2 years, eruptive CNs trended toward more TLF compared with noneruptive CNs (Kaplan-Meier estimates, 19.8% vs 12.5%; P = 0.11) and significantly more target lesion revascularization (18.3% vs 9.6%; P = 0.04). In the adjusted model, eruptive CNs were independently associated with 2-year TLF (HR: 2.07; 95% CI: 1.01-4.50; P = 0.048). CONCLUSIONS Compared with noneruptive CN morphology, lesions with an eruptive CN appearance on optical coherence tomography had a worse poststent long-term clinical outcome despite better acute stent expansion.
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Affiliation(s)
- Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Kei Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar K Khalique
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Susan V Thomas
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Anna Tsoulios
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA.
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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16
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Ali ZA, Karimi Galougahi K, Thomas SV, Abu-Much A, Chau K, Dakroub A, Shlofmitz ES, Jeremias A, West N, Matsumura M, Mintz GS, Maehara A, Shlofmitz RA. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention: Practical Application. Interv Cardiol Clin 2023; 12:215-224. [PMID: 36922062 DOI: 10.1016/j.iccl.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Optical coherence tomography (OCT) provides high-resolution imaging of coronary arteries and can be used to optimize percutaneous coronary intervention (PCI). Intracoronary OCT, however, has had limited adoption in clinical practice. Novelty and relative complexity of OCT interpretation compared with the more established intravascular ultrasound, lack of a standardized algorithm for PCI guidance, paucity of data from randomized trials, and lack of rebate for intravascular imaging have contributed to the modest practical adoption of OCT. We provide a practical step-by-step guide on how to use OCT in PCI, including device set-up, simplified image interpretation, and an algorithmic approach for PCI. optimization.
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Affiliation(s)
- Ziad A Ali
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA.
| | - Keyvan Karimi Galougahi
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Arsalan Abu-Much
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Karen Chau
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Evan S Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Nick West
- Abbott Vascular, 3200 Lakeside Drive #5314, Santa Clara, CA 95054, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
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17
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Sato T, Yamamoto K, Sugizaki Y, Matsumura M, Shlofmitz E, Moses JW, Khalique OK, Thomas S, Cohen D, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. PRE-PCI OCT NODULAR CALCIUM MORPHOLOGY AND ITS IMPACT ON POST-PCI CLINICAL OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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18
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Ali ZA, Jeremias A. ResETTing the diagnostic utility of exercise tolerance testing for INOCA. EUROINTERVENTION 2023; 18:e1035-e1037. [PMID: 36760208 PMCID: PMC9909451 DOI: 10.4244/eij-e-22-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Ziad A Ali
- St. Francis Hospital, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
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19
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Jeremias A. Coronary Physiology to Optimize Percutaneous Coronary Intervention. Interv Cardiol Clin 2023; 12:xv-xvi. [PMID: 36372467 DOI: 10.1016/j.iccl.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Allen Jeremias
- Cardiac Catheterization Laboratory, St. Francis Hospital & Heart Center, 100 Port Washington Boulevard, Suite #105, Roslyn, NY 11576, USA.
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20
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Lundy EF, Karimi Galougahi K, Dominguez-Sulca D, Chowdhury E, Thomas SV, Porter CR, Mintz GS, Matsumura M, Maehara A, Cohen DJ, Moses JW, Shlofmitz ES, Jeremias A, West NEJ, Robinson NB, Shlofmitz RA, Ali ZA. Visualizing Inside Conduits-Intraoperative Screening of Grafts by Optical Coherence Tomography. Ann Thorac Surg 2023; 115:266-271. [PMID: 35970228 DOI: 10.1016/j.athoracsur.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Saphenous vein graft (SVG) failure is a complex phenomenon, with technical, biologic, and local factors contributing to early and medium- and long-term failure after coronary artery bypass graft. Both technical and conduit factors may have significant impact on early SVG failure. DESCRIPTION We review the complex factors that play a pathogenic role in SVG failure, followed by review of the existing literature on potential utility of high-definition optical coherence tomography (OCT) in comprehensive intraoperative assessment of SVGs. EVALUATION We describe a new technique for intraoperative acquisition of OCT images in the harvested SVGs and introduce a classification system for pathologic processes that can be detected in the harvested SVG conduits by OCT. CONCLUSIONS The potential impact on early graft failure of the exclusion of segments of SVGs that are less than optimal (ie, containing fibroatheroma, retained thrombus, sclerotic valves, or procurement injury) will be examined in the randomized controlled OCTOCAB (Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery) trial.
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Affiliation(s)
| | | | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Ziad A Ali
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
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21
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Siddiqi TJ, Khan MS, Karimi Galougahi K, Shlofmitz E, Moses JW, Rao S, West NEJ, Wolff E, Hochler J, Chau K, Khalique O, Shlofmitz RA, Jeremias A, Ali ZA. Optical coherence tomography versus angiography and intravascular ultrasound to guide coronary stent implantation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S44-S56. [PMID: 36251325 DOI: 10.1002/ccd.30416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is an adjunct to angiography-guided coronary stent placement. However, in the absence of dedicated, appropriately powered randomized controlled trials, the impact of OCT on clinical outcomes is unclear. OBJECTIVE To conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus angiography-guided and intravascular ultrasound (IVUS)-guided coronary stent implantation. METHODS MEDLINE and Cochrane Central were queried from their inception through July 2022 for all studies that sought to compare OCT-guided percutaneous coronary intervention (PCI) to angiography-guided and IVUS-guided PCI. The primary endpoint was minimal stent area (MSA) compared between modalities. Clinical endpoints of interest were all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST). Risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS Thirteen studies (8 randomized control trials and 5 observational studies) enrolling 6312 participants were included. OCT was associated with a strong trend toward increased MSA compared to angiography (MD = 0.36, p = 0.06). OCT-guided PCI was also associated with a reduction in the incidence of all-cause mortality [RR = 0.59, 95% CI (0.35, 0.97), p = 0.04] and cardiovascular mortality [RR = 0.41, 95% CI (0.21, 0.80), p = 0.009] compared with angiography-guided PCI. Point estimates favored OCT relative to angiography in MACE [RR = 0.75, 95% CI (0.47, 1.20), p = 0.22] and MI [RR = 0.75, 95% CI (0.53, 1.07), p = 0.12]. No differences were detected in ST [RR = 0.71, 95% CI (0.21, 2.44), p = 0.58], TLR [RR = 0.71, 95% CI (0.17, 3.05), p = 0.65], or TVR rates [RR = 0.89, 95% CI (0.46, 1.73), p = 0.73]. Compared with IVUS guidance, OCT guidance was associated with a nonsignificant reduction in the MSA (MD = -0.16, p = 0.27). The rates of all-cause and cardiovascular mortality, MACE, MI, TLR, TVR, or ST were similar between OCT-guided and IVUS-guided PCI. CONCLUSIONS OCT-guided PCI was associated with reduced all-cause and cardiovascular mortality compared to angiography-guided PCI. These results should be considered hypothesis generating as the mechanisms for the improved outcomes were unclear as no differences were detected in the rates of TLR, TVR, or ST. OCT- and IVUS-guided PCI resulted in similar post-PCI outcomes.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | - Keyvan Karimi Galougahi
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Jeffrey W Moses
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Sunil Rao
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | | | - Eric Wolff
- St. Francis Hospital, Roslyn, New York, USA
| | | | - Karen Chau
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
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22
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Seike F, Mintz GS, Matsumura M, Ali ZA, Liu M, Jeremias A, Ben-Yehuda O, De Bruyne B, Serruys PW, Yasuda K, Stone GW, Maehara A. Impact of Intravascular Ultrasound-Derived Lesion-Specific Virtual Fractional Flow Reserve Predicts 3-Year Outcomes of Untreated Nonculprit Lesions: The PROSPECT Study. Circ Cardiovasc Interv 2022; 15:851-860. [PMID: 36378741 DOI: 10.1161/circinterventions.121.011198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemodynamic assessment of untreated nonculprit lesions was not studied in the PROSPECT study (Providing Regional Observations to Study Predictors of Events in the Coronary Tree). We developed a virtual intravascular ultrasound-derived lesion-specific fractional flow reserve (lesion-specific IVUS-FFR) algorithm to assess individual lesion-level FFR. We sought to investigate the relation between lesion-specific IVUS-FFR and major adverse cardiovascular events (MACE) arising from untreated nonculprit lesions in the PROSPECT study. METHODS In PROSPECT, 697 patients with acute coronary syndromes underwent 3-vessel grayscale and virtual histology-IVUS to correlate untreated nonculprit plaque morphology with 3-year nonculprit related MACE (composite of cardiac death, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina). Lesion-specific IVUS-FFR was calculated from volumetric IVUS lumen area measurements at 0.4 mm intervals by applying a mathematical circulation model using basic fluid dynamics equations. RESULTS Lesion-specific IVUS-FFR was analyzable in 3227 nonculprit lesions in 660 patients among whom 54 nonculprit MACE events (3 myocardial infarctions) occurred at median 3.4-year follow-up. By receiver-operating characteristic analysis, the best cutoff value of lesion-specific IVUS-FFR to predict nonculprit MACE was ≤0.95. After adjusting for patient and lesion characteristics, lesion-specific IVUS-FFR (hazard ratio, 4.83 [95% CI, 2.20-10.61]; P<0.001) was an independent predictor of 3-year nonculprit MACE, in addition to minimum lumen area≤4.0 mm2, plaque burden ≥70%, and virtual histology thin-cap fibroatheroma. CONCLUSIONS Minor reductions in lesion-specific IVUS-FFR were independently associated with future nonculprit MACE arising from untreated angiographically mild stenoses along with previously established high-risk lesion morphological characteristics. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00180466.
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Affiliation(s)
- Fumiyasu Seike
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (F.S., A.M.)
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.)
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.)
| | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).,Division of Cardiology, University of California, San Diego (O.B.-Y.)
| | | | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (P.W.S.).,Department of Cardiology, Imperial College of London, United Kingdom (P.W.S.)
| | - Kazunori Yasuda
- Department of Mechanical Engineering, Ehime University Graduate School of Science and Engineering, Matsuyama, Japan (K.Y.)
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (F.S., A.M.)
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23
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Shlofmitz RA, Galougahi KK, Jeremias A, Shlofmitz E, Thomas SV, Ali ZA. Calcium Modification in Percutaneous Coronary Interventions. Interv Cardiol Clin 2022; 11:373-381. [PMID: 36243483 DOI: 10.1016/j.iccl.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Moderate-severe calcification increases procedural complications and impairs long-term prognosis post-PCI. Intravascular imaging (particularly optical coherence tomography [OCT]) is useful in guiding the treatment of calcified lesions. Weighted sum of calcium length, arc, and thickness on OCT can predict adequate stent expansion, identifying when atherectomy is required. With intravascular imaging guidance, various techniques alone or in combination may be used in an algorithmic fashion to modify calcified lesions. Calcium fracture by balloon angioplasty, cutting/scoring balloons, intravascular lithotripsy (IVL), atherectomy devices, or Excimer laser improves stent expansion. Intravascular imaging is essential in the treatment of in-stent restenosis when luminal and/or abluminal peri-strut calcium is present.
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Affiliation(s)
- Richard A Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA.
| | - Keyvan Karimi Galougahi
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Evan Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ziad A Ali
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
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24
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Sato T, Yamamoto K, Matsumura M, Moses J, Thomas S, Cohen D, Mintz G, Shlofmitz R, Jeremias A, Ali Z, Maehara A. TCT-285 Prevalence and Anatomical Factors to Be Associated With Stent Underexpansion in Non-Severely Calcified Lesions. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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25
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Chen Z, Matsumura M, Mintz GS, Noguchi M, Fujimura T, Usui E, Seike F, Hu X, Jin G, Li C, Salem H, Fall KN, Shlofmitz E, Kirtane AJ, Cao JJ, Moses JW, Ali ZA, Jeremias A, Shlofmitz RA, Maehara A. Prevalence and Impact of Neoatherosclerosis on Clinical Outcomes After Percutaneous Treatment of Second-Generation Drug-Eluting Stent Restenosis. Circ Cardiovasc Interv 2022; 15:e011693. [PMID: 36126137 DOI: 10.1161/circinterventions.121.011693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical and morphological factors associated with lipidic versus calcified neoatherosclerosis within second-generation drug-eluting stents and the impact of lipidic versus calcified neoatherosclerosis on long-term outcomes after repeat intervention have not been well studied. METHODS A total of 512 patients undergoing optical coherence tomography before percutaneous coronary intervention for second-generation drug-eluting stents in-stent restenosis were included. Neoatherosclerosis was defined as lipidic or calcified neointimal hyperplasia in ≥3 consecutive frames or ruptured lipidic neointimal hyperplasia. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, or clinically driven target lesion revascularization). RESULTS The overall prevalence of neoatherosclerosis was 28.5% (146/512): 56.8% lipidic, 30.8% calcified, and 12.3% both lipidic and calcific. The prevalence increased as a function of time from stent implantation: 20% at 1 to 3 years, 30% at 3 to 7 years, and 75% >7 years. Renal insufficiency, poor lipid profile, and time from stent implantation were associated with lipidic neoatherosclerosis, whereas severe renal insufficiency, female sex, and time from stent implantation were associated with calcified neoatherosclerosis. Multivariable Cox regression revealed that female sex and lipidic neoatherosclerosis were associated with more target lesion failure, whereas stent age and final minimum lumen diameter after reintervention were related to lower target lesion failure. Calcified neoatherosclerosis was not related to adverse events after reintervention for in-stent restenosis given a large enough minimum lumen diameter was achieved. CONCLUSIONS Lipidic but not calcified neoatherosclerosis was associated with poor subsequent outcomes after repeat revascularization if optimal stent expansion was achieved in lesions with calcified neoatherosclerosis.
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Affiliation(s)
- Zhaoyang Chen
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.).,Department of Cardiology, Union Hospital, Fujian Medical University, China (Z.C.)
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Masahiko Noguchi
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Tatsuhiro Fujimura
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Eisuke Usui
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Fumiyasu Seike
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Xun Hu
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Ge Jin
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Chenguang Li
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Hanan Salem
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Khady N Fall
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Evan Shlofmitz
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.)
| | - Ajay J Kirtane
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - J Jane Cao
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.)
| | - Jeffrey W Moses
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Richard A Shlofmitz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Akiko Maehara
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
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Shlofmitz E, Garcia-Garcia HM, Melaku G, Thomas S, Gallant M, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. Evaluation of the Reduction of Thrombus Burden With Cangrelor by OCT Assessment (REDUCE-CLOT) Study. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Petrossian G, Ozdemir D, Galougahi KK, Scheiner J, Thomas SV, Shlofmitz R, Shlofmitz E, Jeremias A, Ali ZA. Role of Intracoronary Imaging in Acute Coronary Syndromes. US Cardiology Review 2022. [DOI: 10.15420/usc.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intravascular imaging with optical coherence tomography (OCT) and intravascular ultrasound provides superior visualization of the culprit plaques for acute coronary syndromes (ACS) compared with coronary angiography. Combined with angiography, intravascular imaging can be used to instigate ‘precision therapy’ for ACS. Post-mortem histopathology identified atherothrombosis at the exposed surface of a ruptured fibrous cap as the main cause of ACS. Further histopathological studies identified intact fibrous caps and calcified nodules as other culprit lesions for ACS. These plaque types were subsequently also identified on intravascular imaging, particularly with the high-resolution OCT. The less-common non-atherothrombotic causes of ACS are coronary artery spasm, coronary artery dissection, and coronary embolism. In this review, the authors provide an overview of clinical studies using intravascular imaging with OCT in the diagnosis and management of ACS.
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Affiliation(s)
| | - Denizhan Ozdemir
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Keyvan Karimi Galougahi
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Heart Research Institute, Sydney, Australia; DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Jonathan Scheiner
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Susan V Thomas
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Richard Shlofmitz
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Evan Shlofmitz
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Allen Jeremias
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
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Jeremias A, Nijjer S, Davies J, DiMario C. Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Patel MR, Jeremias A, Maehara A, Stone GW. Reply: Influence of Target Vessel on Post-PCI iFR. JACC Cardiovasc Interv 2022; 15:793-794. [PMID: 35393111 DOI: 10.1016/j.jcin.2022.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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Shlofmitz E, Garcia-Garcia HM, Melaku G, Thomas S, Gallant M, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. CRT-400.10 Evaluation of the Reduction of Thrombus Burden With Cangrelor by OCT Assessment (REDUCE-CLOT) Study. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, Tang K, Talwar S, Marques K, Shammas NW, Gruberg L, Seto A, Samady H, Sharp ASP, Ali ZA, Mintz G, Davies J, Stone GW. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv 2022; 15:52-61. [PMID: 34991824 DOI: 10.1016/j.jcin.2021.09.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
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Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Zixuan Zhang
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Joel Schneider
- North Carolina Heart and Vascular, Raleigh, North Carolina, USA
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Suneel Talwar
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Koen Marques
- VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Arnold Seto
- Veterans Affairs Medical Center of Long Beach, Long Beach, California, USA
| | - Habib Samady
- Emory University Hospital, Atlanta, Georgia, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, United Kingdom; University of Exeter, Exeter, United Kingdom
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lundy E, Shlofmitz E, Jeremias A, Abou-Eid G, Porter C, Thomas S, Maehara A, Pappas T, Mei N, Scheiner J, Robinson N, Ali Z, Shlofmitz R. TCT-307 Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shlofmitz E, Matsumura M, Maehara A, Moses J, Petrossian G, Abittan M, Kirtane A, Berke A, Pappas T, Chung W, Porter C, Thomas S, Glodan C, Ben-Yehuda O, Cohen D, Kereiakes D, Shlofmitz R, Ali Z, Jeremias A. TCT-273 Impact of Shockwave Intravascular Lithotripsy Induced Calcium Fracture for Treatment of Stent Underexpansion Mediated In-Stent Restenosis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moroni F, Ali ZA, Jeremias A, Azzalini L. Double-kissing nano-crush for bifurcation PCI guided by live OCT imaging: Shedding light on stent positioning. Cardiovasc Revasc Med 2021; 40S:184-186. [PMID: 34657815 DOI: 10.1016/j.carrev.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention (PCI) of bifurcation lesions poses unique challenges and carries a high risk of adverse events on follow-up, mainly driven by repeat revascularization and stent thrombosis. Several techniques exist to tackle bifurcation lesions. Among those, double kissing (DK) crush has emerged in recent years as a safe and effective approach for complex bifurcations requiring a two-stent strategy. In its most recent iteration, the DK nano-crush, minimal (ideally less than 3 mm) side branch stent protrusion into the main branch is recommended, to reduce the number of layers of stent struts at the ostium. Angiographic guidance of stent placement may not allow to achieve optimal positioning. Here we describe a novel approach to DK nano-crush, which employs simultaneous optical coherence tomography to facilitate optimal stent implantation at the side branch ostium.
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Affiliation(s)
- Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; Università Vita-Salute San Raffaele, Milan, Italy
| | - Ziad A Ali
- St. Francis Hospital and DeMatteis Cardiovascular Institute, Roslyn, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | - Allen Jeremias
- St. Francis Hospital and DeMatteis Cardiovascular Institute, Roslyn, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
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Lundy EF, Shlofmitz ES, Jeremias A, Abou-Eid GJ, Porter CR, Thomas SV, Maehara A, Pappas TW, Robinson NB, Ali ZA, Shlofmitz RA. Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery. Circ Cardiovasc Interv 2021; 14:e011109. [PMID: 34592824 DOI: 10.1161/circinterventions.121.011109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Edward F Lundy
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Evan S Shlofmitz
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Allen Jeremias
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.).,Cardiovascular Research Foundation, New York, NY (A.J., A.M., Z.A.A.)
| | - George J Abou-Eid
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Craig R Porter
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Susan V Thomas
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY (A.J., A.M., Z.A.A.)
| | - Thomas W Pappas
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Newell B Robinson
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.).,Cardiovascular Research Foundation, New York, NY (A.J., A.M., Z.A.A.)
| | - Richard A Shlofmitz
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, NY (E.F.L., E.S.S., A.J., G.J.A.-E., C.R.P., S.V.T., T.W.P., N.B.R., Z.A.A., R.A.S.)
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Shlofmitz E, Jeremias A, Parviz Y, Karimi Galougahi K, Redfors B, Petrossian G, Edens M, Matsumura M, Maehara A, Mintz GS, Stone GW, Shlofmitz RA, Ali ZA. External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy. Eur Heart J Cardiovasc Imaging 2021; 22:753-759. [PMID: 33167000 DOI: 10.1093/ehjci/jeaa276] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Optical coherence tomography (OCT)-guided external elastic lamina (EEL)-based stent sizing is safe and as effective as intravascular ultrasound in achieving post-procedural lumen dimensions. However, when compared with automated lumen diameter (LD) measurements, this approach is time-consuming. We aimed to compare vessel diameter measurements and stent diameter selection using either of these approaches and examined whether applying a correction factor to automated LD measurements could result in selecting similar stent diameters to the EEL-based approach. METHODS AND RESULTS We retrospectively compared EEL-based measurements vs. automated LD in reference segments in 154 OCT acquisitions and derived a correction factor for stent sizing using the ratio of EEL to LD measurements. We then prospectively applied the correction factor in 119 OCT acquisitions. EEL could be adequately identified in 100 acquisitions (84%) at the distal reference to allow vessel diameter measurement. Vessel diameters were larger with EEL-based vs. LD measurements at both proximal (4.12 ± 0.74 vs. 3.14 ± 0.67 mm, P < 0.0001) and distal reference segments (3.34 ± 0.75 vs. 2.64 ± 0.65 mm, P < 0.0001). EEL-based downsizing led to selection of larger stents vs. an LD-based upsizing approach (3.33 ± 0.47 vs. 2.70 ± 0.44, P < 0.0001). Application of correction factors to LD [proximal 1.32 (IQR 1.23-1.37) and distal 1.25 (IQR 1.19-1.36)] resulted in discordance in stent sizing by >0.25 mm in 63% and potentially hazardous stent oversizing in 41% of cases. CONCLUSION EEL-based stent downsizing led to selection of larger stent diameters vs. LD upsizing. While applying a correction factor to automated LD measurements resulted in similar mean diameters to EEL-based measurements, this approach cannot be used clinically due to frequent and potentially hazardous stent over-sizing.
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Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
- The Heart Center, St. Francis Hospital, Roslyn, NY, 11576, USA
| | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
- The Heart Center, St. Francis Hospital, Roslyn, NY, 11576, USA
| | - Yasir Parviz
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Keyvan Karimi Galougahi
- Department of Cardiology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, 2050, Australia
| | - Björn Redfors
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
| | | | - Madison Edens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
| | - Akiko Maehara
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - Ziad A Ali
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, 10019, USA
- The Heart Center, St. Francis Hospital, Roslyn, NY, 11576, USA
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Li C, Yang J, Dong S, Dong L, Chen J, Shen L, Zhang F, Li C, Liu H, Hu X, Hau WK, Qian J, Jeremias A, Wang J, Ge J. Multicenter clinical evaluation of a piezoresistive-MEMS-sensor rapid-exchange pressure microcatheter system for fractional flow reserve measurement. Catheter Cardiovasc Interv 2021; 98:E243-E253. [PMID: 33951285 PMCID: PMC8453920 DOI: 10.1002/ccd.29678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/11/2022]
Abstract
Objectives This multicenter, prospective clinical study investigates whether the microelectromechanical‐systems‐(MEMS)‐sensor pressure microcatheter (MEMS‐PMC) is comparable to a conventional pressure wire in fractional flow reserve (FFR) measurement. Background As a conventional tool for FFR measurement, pressure wires (PWs) still have some limitations such as suboptimal handling characteristics and unable to maintain the wire position during pullback assessment. Recently, a MEMS‐PMC compatible with any 0.014″ guidewire is developed. Compared with the existing optical‐sensor PMC, this MEMS‐PMC has smaller profiles at both the lesion crossing and sensor packaging areas. Methods Two hundred and forty‐two patients with visually 30–70% coronary stenosis were enrolled at four centers. FFR was measured first with the MEMS‐PMC, and then with the PW. The primary endpoint was the Bland–Altman mean bias between the MEMS‐PMC and PW FFR. Results From the 224‐patient per‐protocol data, quantitative coronary angiography showed 17.9% and 55.9% vessels had diameter < 2.5 mm and stenosis >50%, respectively. The two systems' mean bias was −0.01 with [−0.08, 0.06] 95% limits‐of‐agreement. Using PW FFR≤0.80 as cutoff, the MEMS‐PMC per‐vessel diagnostic accuracy was 93.4% [95% confidence interval: 89.4–96.3%]. The MEMS‐PMC's success rate was similar to that of PW (97.5 vs. 96.3%, p = .43) with no serious adverse event, and its clinically‐significant (>0.03) drift rate was 43% less (9.5 vs. 16.7%, p = .014). Conclusions Our study showed the MEMS‐PMC is safe to use and has a minimal bias equal to the resolution of current FFR systems. Given the MEMS‐PMC's high measurement accuracy and rapid‐exchange nature, it may become an attractive new tool facilitating routine coronary physiology assessment.
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Affiliation(s)
- Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Shaohong Dong
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Liang Dong
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Li Shen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changling Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Huadong Liu
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - William Kongto Hau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Allen Jeremias
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Seike F, Usui E, Matsumura M, Jeremias A, Shlofmitz E, Ali Z, Nguyen J, Porter C, Cao J, Pappas T, Petrossian G, Moses J, Yasuda K, Mintz G, Shlofmitz R, Maehara A. INTRACORONARY OPTICAL COHERENCE TOMOGRAPHY-DERIVED VIRTUAL FRACTIONAL FLOW RESERVE TO PREDICT POST-PCI OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have persistence or recurrence of angina after angiographically successful percutaneous coronary intervention (PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
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Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, 2nd Floor, B Block, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom
| | - Christopher A. Rajkumar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Allen Jeremias
- Department of Cardiology, St. Francis Hospital, The Heart Center, Roslyn, NY, USA
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40
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Karimi Galougahi K, Shlofmitz E, Jeremias A, Gogia S, Kirtane AJ, Hill JM, Karmpaliotis D, Mintz GS, Maehara A, Stone GW, Shlofmitz RA, Ali ZA. Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies. Curr Cardiol Rep 2021; 23:33. [PMID: 33666772 DOI: 10.1007/s11886-021-01458-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions. RECENT FINDINGS Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.
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Affiliation(s)
- Keyvan Karimi Galougahi
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia.,Heart Research Institute, Sydney, Australia
| | - Evan Shlofmitz
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA
| | - Allen Jeremias
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Shawnbir Gogia
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ziad A Ali
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA. .,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. .,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. .,Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.
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41
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Abstract
Despite consistent clinical data supporting the use of intravascular imaging with percutaneous coronary intervention, utilization remains low. A practical and standardized approach to incorporating intravascular imaging with percutaneous coronary intervention may overcome the barriers to utilization. This review focuses on basic image interpretation with intravascular ultrasound and optical coherence tomography and proposes an algorithmic approach to stent sizing and optimization. Incorporation of this strategic method for percutaneous coronary intervention may aid in the greater adoption of intravascular imaging for percutaneous coronary intervention.
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Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Ziad A. Ali
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Richard Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
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42
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Jeremias A, Nguyen J, Levine J, Pollack S, Engellenner W, Thakore A, Lucore C. Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital. JAMA Intern Med 2020; 180:1707-1709. [PMID: 32780100 PMCID: PMC7420823 DOI: 10.1001/jamainternmed.2020.4214] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This cross-sectional study assesses the rate of COVID-19 infection among health care workers in a large community hospital.
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Affiliation(s)
- Allen Jeremias
- Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
| | - James Nguyen
- Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
| | - Joseph Levine
- Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
| | - Simcha Pollack
- Department of Biostatistics, St Francis Hospital, The Heart Center, Roslyn, New York
| | - William Engellenner
- Department of Laboratory Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
| | - Avni Thakore
- Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
| | - Charles Lucore
- Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
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43
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Chen LQ, Burdowski J, Marfatia R, Weber J, Gliganic K, Diaz N, Ramjattan N, Zheng H, Mihalatos D, Wang L, Barasch E, Leung A, Gopal A, Craft J, Ren X, Stergiopoulos K, Jeremias A, Petrossian G, Robinson N, Levine J, Shlofmitz RA, Gulotta RJ, Muehlbauer SM, Lucore CL, Cao JJ. Reduced cardiac function is associated with cardiac injury and mortality risk in hospitalized COVID-19 Patients. Clin Cardiol 2020; 43:1547-1554. [PMID: 33280140 PMCID: PMC7675371 DOI: 10.1002/clc.23479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Cardiac injury is common in COVID‐19 patients and is associated with increased mortality. However, it remains unclear if reduced cardiac function is associated with cardiac injury, and additionally if mortality risk is increased among those with reduced cardiac function in COVID‐19 patients. Hypothesis The aim of this study was to assess cardiac function among COVID‐19 patients with and without biomarkers of cardiac injury and to determine the mortality risk associated with reduced cardiac function. Methods/Results This retrospective cohort study analyzed 143 consecutive COVID‐19 patients who had an echocardiogram during hospitalization between March 1, 2020 and May 5, 2020. The mean age was 67 ± 16 years. Cardiac troponin‐I was available in 131 patients and an increased value (>0.03 ng/dL) was found in 59 patients (45%). Reduced cardiac function, which included reduced left or right ventricular systolic function, was found in 40 patients (28%). Reduced cardiac function was found in 18% of patients without troponin‐I elevation, 42% with mild troponin increase (0.04‐5.00 ng/dL) and 67% with significant troponin increase (>5 ng/dL). Reduced cardiac function was also present in more than half of the patients on mechanical ventilation or those deceased. The in‐hospital mortality of this cohort was 28% (N = 40). Using logistic regression analysis, we found that reduced cardiac function was associated with increased mortality with adjusted odds ratio (95% confidence interval) of 2.65 (1.18 to 5.96). Conclusions Reduced cardiac function is highly prevalent among hospitalized COVID‐19 patients with biomarkers of myocardial injury and is independently associated with mortality.
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Affiliation(s)
- Lu Q. Chen
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Joseph Burdowski
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Ravi Marfatia
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Jonathan Weber
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Kathleen Gliganic
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Nancy Diaz
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Neiman Ramjattan
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Haoyi Zheng
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Dennis Mihalatos
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Lin Wang
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Eddy Barasch
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Amanda Leung
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Aasha Gopal
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Jason Craft
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Xiaoli Ren
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Kathleen Stergiopoulos
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Allen Jeremias
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - George Petrossian
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Newell Robinson
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Joseph Levine
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Richard A. Shlofmitz
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Ronald J. Gulotta
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Stefan M. Muehlbauer
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - Charles L. Lucore
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
| | - J. Jane Cao
- Department of Research and Department of CardiologySt Francis Hospital, The Heart CenterRoslynNew YorkUSA
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44
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Kim CH, Koo BK, Dehbi HM, Lee JM, Doh JH, Nam CW, Shin ES, Cook CM, Al-Lamee R, Petraco R, Sen S, Malik IS, Nijjer SS, Mejía-Rentería H, Alegria-Barrero E, Alghamdi A, Altman J, Baptista SB, Bhindi R, Bojara W, Brugaletta S, Silva PC, Di Mario C, Erglis A, Gerber RT, Going O, Härle T, Hellig F, Indolfi C, Janssens L, Jeremias A, Kharbanda RK, Khashaba A, Kikuta Y, Krackhardt F, Laine M, Lehman SJ, Matsuo H, Meuwissen M, Niccoli G, Piek JJ, Ribichini F, Samady H, Sapontis J, Seto AH, Sezer M, Sharp ASP, Singh J, Takashima H, Talwar S, Tanaka N, Tang K, Van Belle E, van Royen N, Vinhas H, Vrints CJ, Walters D, Yokoi H, Samuels B, Buller C, Patel MR, Serruys PW, Escaned J, Davies JE. Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy. JACC Cardiovasc Interv 2020; 12:2035-2046. [PMID: 31648764 DOI: 10.1016/j.jcin.2019.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)- and fractional flow reserve (FFR)-guided revascularization strategies. BACKGROUND An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. METHODS This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. RESULTS Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). CONCLUSIONS An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (Functional Lesion Assessment of Intermediate Stenosis to guide Revascularization [DEFINE-FLAIR]; NCT02053038).
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Affiliation(s)
- Chee Hae Kim
- Division of Cardiology, Department of Internal Medicine, VHS Medical Center, Seoul, South Korea
| | - Bon-Kwon Koo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea; Institute on Aging, Seoul National University, Seoul, South Korea.
| | - Hakim-Moulay Dehbi
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Daehwa-dong, South Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea
| | | | - Rasha Al-Lamee
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Ricardo Petraco
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Sayan Sen
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | | | - Hernán Mejía-Rentería
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ali Alghamdi
- King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia
| | - John Altman
- Colorado Heart and Vascular, Lakewood, Colorado
| | | | | | - Waldemar Bojara
- Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Carlo Di Mario
- Royal Brompton Hospital, Imperial College London, London, United Kingdom; University of Florence, Florence, Italy
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Olaf Going
- Sana Klinikum Lichtenberg, Lichtenberg, Germany
| | - Tobias Härle
- Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany
| | | | | | | | - Allen Jeremias
- Stony Brook University Medical Center, New York, New York
| | - Rajesh K Kharbanda
- John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | | | | | | | - Mika Laine
- Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | - Jan J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Arnold H Seto
- Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Murat Sezer
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Andrew S P Sharp
- Royal Devon and Exeter Hospital, University of Exeter, Exeter, United Kingdom
| | - Jasvindar Singh
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Suneel Talwar
- Royal Bournemouth General Hospital, Bournemouth, United Kingdom
| | | | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin University, Chelmsford, United Kingdom
| | - Eric Van Belle
- Institut Coeur Poumon, Lille University Hospital, Lille, France; UMR INSERM 1011, Centre Hospitalier Universitaire de Lille et de Institut Pasteur de Lille, Université de Lille, Lille, France
| | | | | | | | | | | | - Bruce Samuels
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | - Patrick W Serruys
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Justin E Davies
- Hammersmith Hospital, Imperial College London, London, United Kingdom
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Wolny R, Mintz GS, Matsumura M, Kim SY, Ishida M, Fujino A, Lee T, Shlofmitz E, Goldberg A, Liu Y, Zhang Z, Zhang M, Hu X, Jeremias A, Petrossian G, Shlofmitz RA, Maehara A. Left coronary artery calcification patterns after coronary bypass graft surgery: An in-vivo optical coherence tomography study. Catheter Cardiovasc Interv 2020; 98:483-491. [PMID: 32915510 DOI: 10.1002/ccd.29220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We sought to evaluate the severity and patterns of calcifications in the left main coronary artery (LMCA) and proximal segments of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) using optical coherence tomography (OCT) in patients with and without prior coronary artery bypass grafting (CABG). BACKGROUND CABG may accelerate upstream calcium development. METHODS OCT images (n = 76) of the LMCA bifurcation from either the LAD or LCX in 76 patients with at least one patent left coronary graft, on average 7.0 ± 5.6 years post-CABG, were compared with 148 OCT images in propensity-score-matched non-CABG controls. RESULTS Minimum lumen areas in the LMCA, LAD, and LCX in post-CABG patients were smaller than non-CABG controls. Maximum calcium arc and thickness as well as calcium length were greater in the LMCA and LCX, but not in the LAD in post-CABG patients versus non-CABG controls. Calcium located at the carina of a bifurcation, calcified nodules (CN), thin intimal calcium, and lobulated calcium were more prevalent in post-CABG patients. After adjusting for multiple covariates, prior CABG was an independent predictor of calcification at the carina of a bifurcation (odds ratio [OR] 5.77 [95% confidence interval, CI: 1.5-21.6]), thin intimal calcium (4.7 [1.5-14.4]), and the presence of a CN (15.60 [3.2-76.2]). CONCLUSIONS Prior CABG is associated with greater amount of calcium in the LMCA and the proximal LCX, as well as higher prevalence of atypical calcium patterns, including CN, thin or lobulated calcium, and calcifications located at the carina of a bifurcation, compared with non-CABG controls.
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Affiliation(s)
- Rafal Wolny
- National Institute of Cardiology, Warsaw, Poland.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Song-Yi Kim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Masaru Ishida
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Akiko Fujino
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Evan Shlofmitz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | | | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mingyou Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Xun Hu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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46
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Naidu SS, Coylewright M, Hawkins BM, Meraj P, Morray BH, Devireddy C, Ing F, Klein AJ, Seto AH, Grines CL, Henry TD, Rao SV, Duffy PL, Amin Z, Aronow HD, Box LC, Caputo RP, Cigarroa JE, Cox DA, Daniels MJ, Elmariah S, Fagan TE, Feldman DN, Forbes TJ, Hermiller JB, Herrmann HC, Hijazi ZM, Jeremias A, Kavinsky CJ, Latif F, Parikh SA, Reilly J, Rosenfield K, Swaminathan RV, Szerlip M, Yakubov SJ, Zahn EM, Mahmud E, Bhavsar SS, Blumenthal T, Boutin E, Camp CA, Cromer AE, Dineen D, Dunham D, Emanuele S, Ferguson R, Govender D, Haaf J, Hite D, Hughes T, Laschinger J, Leigh SM, Lombardi L, McCoy P, McLean F, Meikle J, Nicolosi M, O'Brien J, Palmer RJ, Patarca R, Pierce V, Polk B, Prince B, Rangwala N, Roman D, Ryder K, Tolve MH, Vang E, Venditto J, Verderber P, Watson N, White S, Williams DM. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank. Catheter Cardiovasc Interv 2020; 96:1258-1265. [PMID: 32840956 DOI: 10.1002/ccd.29197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/05/2022]
Abstract
The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Frank Ing
- UC Davis Medical Center, Los Angeles, California, USA
| | | | - Arnold H Seto
- Long Beach VA Health Care System, Long Beach, California, USA
| | - Cindy L Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina, USA
| | - Peter L Duffy
- First Health Cardiology-Pinehurst, Pinehurst, North Carolina, USA
| | - Zahid Amin
- Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Lyndon C Box
- West Valley Medical Center, Caldwell, Idaho, USA
| | | | | | - David A Cox
- Cardiovascular Associates, Birmingham, Alabama, USA
| | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas E Fagan
- Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | | | | | - James B Hermiller
- The St. Vincent Medical Group at The Heart Center, Indianapolis, Indiana, USA
| | - Howard C Herrmann
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Ziyad M Hijazi
- Weill Cornell Medical College, New York, NY. Sidra Medical and Research Center, Doha, Qatar
| | - Allen Jeremias
- St. Francis Hospital, The Heart Hospital, Roslyn, New York, USA
| | | | - Faisal Latif
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sahil A Parikh
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - John Reilly
- Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | | | - Steve J Yakubov
- OhioHealth Heart & Vascular Physicians, Coshocton, Ohio, USA
| | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, San Diego, California, USA
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- Philips Healthcare, San Diego, California, USA
| | | | - Tico Blumenthal
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | - Joel Haaf
- Philips Healthcare, San Diego, California, USA
| | - Denise Hite
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | | | | | - Roberto Patarca
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | - Bucky Polk
- Philips Healthcare, San Diego, California, USA
| | | | | | - Dana Roman
- Janssen Pharmaceuticals, Raritan, New Jersey, USA
| | - Ken Ryder
- Abiomed, Danvers, Massachusetts, USA
| | | | - Eric Vang
- Medtronic, Minneapolis, Minnesota, USA
| | | | - Paula Verderber
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | - Nancy Watson
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
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Jeremias A, Stone GW. Assessing Post-Percutaneous Coronary Intervention Physiology: Is Hyperemia Necessary? JACC Cardiovasc Interv 2020; 13:1934-1936. [PMID: 32819482 DOI: 10.1016/j.jcin.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Allen Jeremias
- Department of Cardiology, St. Francis Hospital, the Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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48
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Parikh PB, Wang TY, Sharma N, Kort S, Skopicki HA, Gruberg L, Jeremias A, Pyo R, Chikwe J, Butler J. Sex-Related Differences in Early- and Long-Term Mortality After Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Invasive Cardiol 2020; 32:295-301. [PMID: 32198317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Observational data suggest that early- and long-term outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) differ significantly between men and women, but have demonstrated conflicting results. This study sought to examine early- and long-term mortality with TAVR and SAVR in women versus men. METHODS Electronic search was performed until February 2018 for studies reporting sex-specific mortality following TAVR or isolated SAVR. Data were pooled using random-effects models. Outcomes included rates of early mortality (in hospital or 30 days) and long term (1 year or longer). RESULTS With 35 studies, a total of 80,928 patients were included in our systematic review and meta-analysis, including 40,861 men and 40,067 women. Pooled analyses suggested considerable sex-related differences in longterm mortality following TAVR and SAVR. Following SAVR, women had higher long-term mortality (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.16-1.56; P<.001) and a trend toward higher early mortality (OR, 1.69; 95% CI, 0.97-2.97; P=.07) compared to men. Following TAVR, women had lower long-term mortality (OR, 0.78; 95% CI, 0.71-0.86; P<.001) and no difference in early mortality (OR, 1.09; 95% CI, 0.96-1.23; P=.17) compared to men. CONCLUSIONS In this systematic review and meta-analysis, women had higher long-term mortality and a trend toward higher early mortality compared to men following SAVR. Following TAVR, women had lower long-term mortality and no difference in early mortality compared with men.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook University Medical Center, Health Sciences Center T16-080, Stony Brook, NY 11794 USA. puja.parikh@ stonybrookmedicine.edu
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49
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Lee JM, Choi KH, Koo BK, Dehbi HM, Doh JH, Nam CW, Shin ES, Cook CM, Al-Lamee R, Petraco R, Sen S, Malik IS, Nijjer SS, Mejía-Rentería H, Alegria-Barrero E, Alghamdi A, Altman J, Baptista SB, Bhindi R, Bojara W, Brugaletta S, Silva PC, Di Mario C, Erglis A, Gerber RT, Going O, Härle T, Hellig F, Indolfi C, Janssens L, Jeremias A, Kharbanda RK, Khashaba A, Kikuta Y, Krackhardt F, Laine M, Lehman SJ, Matsuo H, Meuwissen M, Niccoli G, Piek JJ, Ribichini F, Samady H, Sapontis J, Seto AH, Sezer M, Sharp ASP, Singh J, Takashima H, Talwar S, Tanaka N, Tang K, Van Belle E, van Royen N, Vinhas H, Vrints CJ, Walters D, Yokoi H, Samuels B, Buller C, Patel MR, Serruys P, Escaned J, Davies JE. Comparison of Major Adverse Cardiac Events Between Instantaneous Wave-Free Ratio and Fractional Flow Reserve-Guided Strategy in Patients With or Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2020; 4:857-864. [PMID: 31314045 DOI: 10.1001/jamacardio.2019.2298] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Invasive physiologic indices such as fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are used in clinical practice. Nevertheless, comparative prognostic outcomes of iFR-guided and FFR-guided treatment in patients with type 2 diabetes have not yet been fully investigated. Objective To compare 1-year clinical outcomes of iFR-guided or FFR-guided treatment in patients with and without diabetes in the Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularization (DEFINE-FLAIR) trial. Design, Setting, and Participants The DEFINE-FLAIR trial is a multicenter, international, randomized, double-blinded trial that randomly assigned 2492 patients in a 1:1 ratio to undergo either iFR-guided or FFR-guided coronary revascularization. Patients were eligible for trial inclusion if they had intermediate coronary artery disease (40%-70% diameter stenosis) in at least 1 native coronary artery. Data were analyzed between January 2014 and December 2015. Interventions According to the study protocol, iFR of 0.89 or less and FFR of 0.80 or less were used as criteria for revascularization. When iFR or FFR was higher than the prespecified threshold, revascularization was deferred. Main Outcomes and Measures The primary end point was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. The incidence of MACE was compared according to the presence of diabetes in iFR-guided and FFR-guided groups. Results Among the total trial population (2492 patients), 758 patients (30.4%) had diabetes. Mean age of the patients was 66 years, 76% were men (1868 of 2465), and 80% of patients presented with stable angina (1983 of 2465). In the nondiabetes population (68.5%; 1707 patients), iFR guidance was associated with a significantly higher rate of deferral of revascularization than the FFR-guided group (56.5% [n = 477 of 844] vs 46.6% [n = 402 of 863]; P < .001). However, it was not different between the 2 groups in the diabetes population (42.1% [n = 161 of 382] vs 47.1% [n = 177 of 376]; P = .15). At 1 year, the diabetes population showed a significantly higher rate of MACE than the nondiabetes population (8.6% vs 5.6%; adjusted hazard ratio [HR], 1.88; 95% CI, 1.28-2.64; P < .001). However, there was no significant difference in MACE rates between iFR-guided and FFR-guided groups in both the diabetes (10.0% vs 7.2%; adjusted HR, 1.33; 95% CI, 0.78-2.25; P = .30) and nondiabetes population (4.7% vs 6.4%; HR, 0.83; 95% CI, 0.51-1.35; P = .45) (interaction P = .25). Conclusions and Relevance The diabetes population showed significantly higher risk of MACE than the nondiabetes population, even with the iFR-guided or FFR-guided treatment. The iFR-guided and FFR-guided treatment showed comparable risk of MACE and provided equal safety in selecting revascularization target among patients with diabetes. Trial Registration ClinicalTrials.gov identifier: NCT02053038.
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Affiliation(s)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital and Institute on Aging, Seoul National University, Seoul, South Korea
| | - Hakim-Moulay Dehbi
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, England
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Seok Shin
- Ulsan Hospital, Ulsan, South Korea and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | - Rasha Al-Lamee
- Hammersmith Hospital, Imperial College London, London, England
| | - Ricardo Petraco
- Hammersmith Hospital, Imperial College London, London, England
| | - Sayan Sen
- Hammersmith Hospital, Imperial College London, London, England
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College London, London, England
| | | | - Hernán Mejía-Rentería
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ali Alghamdi
- King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia
| | - John Altman
- Colorado Heart and Vascular, Lakewood, Colorado
| | | | | | - Waldemar Bojara
- Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Carlo Di Mario
- Royal Brompton Hospital, Imperial College London, London, England.,University of Florence, Florence, Italy
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Olaf Going
- Sana Klinikum Lichtenberg, Lichtenberg, Germany
| | - Tobias Härle
- Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany
| | | | | | | | - Allen Jeremias
- Stony Brook University Medical Center, New York, New York
| | - Rajesh K Kharbanda
- John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, England
| | | | | | | | - Mika Laine
- Helsinki University Hospital, Helsinki, Finland
| | - Sam J Lehman
- Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Jan J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - James Sapontis
- Monash Heart, Monash University, Melbourne, Victoria, Australia
| | - Arnold H Seto
- Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Murat Sezer
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Andrew S P Sharp
- Royal Devon and Exeter Hospital, Exeter, England.,University of Exeter, Exeter, England
| | - Jasvindar Singh
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Suneel Talwar
- Royal Bournemouth General Hospital, Bournemouth, England
| | | | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, England.,Anglia Ruskin University, Chelmsford, England
| | - Eric Van Belle
- Institut Coeur Poumon, Lille University Hospital, Lille, France.,INSERM Unité 1011, Lille, France
| | | | | | | | - Darren Walters
- Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Bruce Samuels
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | - Patrick Serruys
- Hammersmith Hospital, Imperial College London, London, England
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Justin E Davies
- Hammersmith Hospital, Imperial College London, London, England
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50
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Matsumura M, Maehara A, Davies JE, Sharp A, Samady H, Seto AH, Ali ZA, Stone GW, Patel MR, Jeremias A. Intensive Training and Real-Time Quality Control by a Physiology Core Laboratory: Lessons From DEFINE-PCI. Circ Cardiovasc Interv 2020; 13:e009077. [PMID: 32611202 DOI: 10.1161/circinterventions.120.009077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.)
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,Columbia University Irving Medical Center, New York, NY (A.M., Z.A.A.)
| | - Justin E Davies
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom (J.E.D,)
| | - Andrew Sharp
- University Hospital of Wales and University of Exeter, Cardiff, United Kingdom (A.S.).,Emory University Hospital, Atlanta, GA (A.S.)
| | | | - Arnold H Seto
- Long Beach VA Medical Center, Long Beach, CA (A.H.S.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,Columbia University Irving Medical Center, New York, NY (A.M., Z.A.A.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
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