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Castaldi G, Kovacic M, Poletti E, Benedetti A, Moroni A, Scott B, Wilgenhof A, Bezzeccheri A, Vescovo G, Budassi S, El Jattari H, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Tumscitz C, Agostoni P. Minimalistic Hybrid Approach for the Percutaneous Treatment of Coronary Chronic Total Occlusions: Midterm Follow-Up of an International Multicenter Cohort. Am J Cardiol 2024; 214:77-84. [PMID: 38160923 DOI: 10.1016/j.amjcard.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
The minimalistic hybrid approach (MHA) is a recently proposed algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI), reducing the overall invasiveness of the procedure without impacting the acute results. However, data on midterm results are lacking. This study aimed to evaluate the midterm clinical outcomes of a multicenter international cohort of CTO PCI treated according to the MHA. Data from a consecutive series of patients with a CTO who underwent PCI according to the MHA between February 2019 and March 2022 were prospectively collected in 3 European centers and retrospectively analyzed. The main outcome was the first occurrence of a major adverse cardiac event (MACE), defined as a composite outcome of all-cause death, any myocardial infarction, and target vessel revascularization, at the last follow-up available. A total of 212 patients were included. The majority of the patients were symptomatic for angina (Canadian Cardiovascular Society class 2 or 3: 63.7%) at the time of the index procedure. The mean Japanese-CTO and CASTLE scores were 2.1 ± 1.2 and 2.0 ± 1.3, respectively. Technical success (CTO open with optimal flow) was achieved in 198 patients (93.9%) and procedural success (technical success without in-hospital MACEs) in 195 (91.9%). At the last follow-up available (median 677 days), the cumulative incidence rate of MACEs was 11.5%; in particular, all-cause death was 7.4%, any myocardial infarction was 4.3%, and unplanned target vessel revascularization was 6.5%. In conclusion, the midterm results of the MHA seem to be in line with contemporary results of other CTO PCI algorithms, thus potentially validating the MHA as a valuable alternative, provided that interventionalists are already expert CTO operators and accustomed to the definitions and peculiarities of MHA.
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Affiliation(s)
- Gianluca Castaldi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Enrico Poletti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Moroni
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- Cardiovascular Center Aalst, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Andrea Bezzeccheri
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giovanni Vescovo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Hicham El Jattari
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carl Convens
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Tumscitz
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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Benedetti A, Castaldi G, Poletti E, Moroni A, El Jattari H, Scott B, Convens C, Verheye S, Vermeersch P, Agostoni P, Zivelonghi C. In-vitro validation of coronary physiology assessment with 5 French guiding catheters. Cardiovasc Revasc Med 2024; 60:55-63. [PMID: 37863759 DOI: 10.1016/j.carrev.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The trans-radial approach for cardiac catheterization led to an increasing adoption of 5 French (F) catheters. We aim to evaluate reliability and reproducibility of coronary physiology assessment performed with 5F guiding catheter (GC). METHODS Physiological measurements were performed in a coronary flow simulator, which provides two pulsatile flows, the baseline and hyperaemic flows. Two screws, positioned proximally and distally to the distal sensor of a pressure-temperature guidewire, were used to determine various combinations of stenoses and distal obstructions, simulating different pathophysiological conditions. For each setting, 5 measurements of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microvascular resistance (IMR) were performed with 6F and 5F GCs. RESULTS A total amount of 190 measurements were performed, 95 with 6F GC and 95 with 5F GC. Minimal differences between 6F and 5F GCs were detected for FFR [0.91 (IQR: 0.87-0.94) and 0.87 (IQR: 0.82-0.92) respectively, p < 0.001] and IMR (16.5 ± 8.8 and 15.4 ± 8.3 respectively, p = 0.001). Mean CFR was comparable between 6F and 5F GCs (3.6 ± 1.1 and 3.5 ± 0.7 respectively, p = 0.38). Misclassification rates were 1.0 %, 1.0 % and 0 % for FFR, CFR and IMR, respectively. According to Passing-Bablok analysis, an excellent agreement between 6F and 5F GCs was demonstrated for FFR and IMR, and a modest agreement for CFR. All measurements with 5F GC showed high reproducibility. CONCLUSIONS In our in-vitro model, a complete physiological assessment including FFR, CFR and IMR resulted substantially comparable between 6F and 5F GCs. Further in-vivo analysis is required to support these findings.
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Affiliation(s)
- Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
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Moroni A, Poletti E, Scott B, Castaldi G, El Jattari H, Benedetti A, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Agostoni P. Prevalence of Collateral Typology in Coronary Chronic Total Occlusion and Its Impact on Percutaneous Intervention Performance. Am J Cardiol 2024; 210:153-162. [PMID: 37898156 DOI: 10.1016/j.amjcard.2023.09.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/30/2023]
Abstract
The presence of collateral channels providing distal blood supply is a distinctive characteristic of chronic total occlusion (CTO) lesions. However, data about the distinct baseline and procedural characteristics of each collateral subset are scarce. Accordingly, we sought to explore the procedural aspects specific for each collateral typology (ipsilateral collaterals [ICs], contralateral collaterals [CCs] or mixed) in CTO-percutaneous coronary intervention (PCI). A retrospective analysis of our CTO-PCI registry was performed to investigate the prevalence, procedural characteristics, and outcomes specific for each CTO-PCI subset, defined according to the inter-arterial connection anatomy. A total of 209 cases were included. Of the included cases, 45 (22%) and 92 (44%) patients displayed solely IC or CC, respectively, whereas in 72 (34%) both IC and CC were present (mixed). The procedural success rate was high (91.1%) and comparable among the different groups, despite greater lesion complexity in the CC group. The most frequent target vessel was the left circumflex in the IC group (51% of cases) and the right coronary artery in the CC (63%) and mixed (57%) groups. Among the IC cases, 42% showed a poor collateral connection function (2% and 10% for the CC and mixed group, respectively), and 46% showed a suboptimal collateral recipient artery filling (21% and 20% for the CC and mixed group, respectively). Most of the IC cases were performed using a single access (96%). In conclusion, the success and complication rates were comparable among the collateral typology groups, irrespective of the differences in the baseline and procedural characteristics. Phenotyping CTO as hereby proposed might be helpful for targeted procedural considerations.
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Affiliation(s)
- Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Clinical and Interventional Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Vanharen Y, Abugattas de Torres JP, Adriaenssens B, Convens C, Schwagten B, Tijskens M, Wolf M, Goossens E, Van Bogaert P, de Greef Y. Nurse-led care after ablation of atrial fibrillation: a randomized controlled trial. Eur J Prev Cardiol 2023; 30:1599-1607. [PMID: 37067048 DOI: 10.1093/eurjpc/zwad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
AIMS The added value of advanced practitioner nurse (APN) care after ablation of atrial fibrillation (AF) is unknown. The present study investigates the impact of APN-led care on AF recurrence, patient knowledge, lifestyle, and patient satisfaction. METHODS AND RESULTS Sixty-five patients undergoing AF ablation were prospectively randomized to usual care (N = 33) or intervention (N = 32) group. In addition to usual care, the intervention consisted of an educational session, three consultations spread over 6 months and telephone accessibility coordinated by the APN. Primary outcome was the AF recurrence rate at 6-month follow-up. Secondary outcomes were lifestyle factors (alcohol intake, exercise, BMI, smoking), patient satisfaction and AF knowledge measured at 1 and 6 months between groups and within each group. Study demographics at 1 month were similar, except AF knowledge was higher in the intervention group (8.6 vs. 7, P = 0.001). At 6 months, AF recurrence was significantly lower in the intervention group (13.5 vs. 39.4%, P = 0.014). Between groups, patient satisfaction and AF knowledge were significantly higher in the intervention group, respectively, 9.4 vs. 8.7 (P < 0.001) and 8.6 vs. 7.0 out of 10 (P < 0.001). Within the intervention group, alcohol intake decreased from 3.9 to 2.6 units per week (P = 0.031) and physical activity increased from 224.4 ± 210.7 to 283.8 ± 169.3 (P = 0.048). No changes occurred within the usual care group. Assignment to the intervention group was the only protective factor for AF recurrence [Exp(B) 0.299, P = 0.04] in multivariable-adjusted analysis. CONCLUSION Adding APN-led care after ablation of AF improves short-term clinical outcome, patient satisfaction and physical activity and decreases alcohol intake.
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Affiliation(s)
- Yaël Vanharen
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
| | | | - Bert Adriaenssens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Department of Cardiology, AZ Sint-Niklaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Carl Convens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Bruno Schwagten
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Maxime Tijskens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Michael Wolf
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Eva Goossens
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
- Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Peter Van Bogaert
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
| | - Yves de Greef
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
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Poletti E, Castaldi G, Scott B, Benedetti A, Moroni A, El Jattari H, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Agostoni P. Alternative (Transulnar or Distal Radial) Arterial Access for Chronic Total Occlusion Percutaneous Coronary Intervention (Subanalysis from the Minimalistic Hybrid Approach Algorithm Registry). Am J Cardiol 2023; 200:57-65. [PMID: 37300902 DOI: 10.1016/j.amjcard.2023.05.005] [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: 03/26/2023] [Revised: 04/15/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
The transradial approach (TRA) has become the primary choice for percutaneous coronary intervention (PCI); however, it may not be always feasible because of clinical and/or technical challenges. Alternative forearm accesses, such as transulnar approach (TUA) and distal radial approach (dTRA) may allow maintaining a wrist approach for the procedure, avoiding the femoral artery. This issue is particularly relevant in patients who underwent multiple revascularizations, such as those with chronic total occlusion (CTO) lesions. This study aimed to evaluate whether the use of TUA and/or dTRA is comparable with TRA in CTO PCI using a minimalistic hybrid approach algorithm, which limits the number of accesses used to minimize vascular access complications. Patients with CTO PCI treated solely through a fully alternative approach (TUA and/or dTRA) were compared with those treated solely through a standard TRA approach. The primary efficacy end point was procedural success, whereas the primary safety end point was the composite of major adverse cardiac and cerebral events and vascular complications. Of 201 CTO PCIs attempted, 154 procedures were considered for analysis (standard, n = 104, alternative, n = 50). Alternative and standard groups demonstrated comparable rates of both procedural success (92% vs 94.2%, p = 0.70) and primary safety end point (4.8% vs 6.0%, p = 0.70). Of interest, 7 French guiding catheters were more frequently used in the alternative group (44% vs 26%, p = 0.028). In conclusion, CTO PCI after minimalistic hybrid approach by way of alternative forearm vascular accesses (dTRA and/or TUA) is feasible and safe to perform, compared with CTO PCI by way of standard TRA.
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Affiliation(s)
- Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Clinical and Interventional Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Benedetti A, Castaldi G, Poletti E, Moroni A, Scott B, Convens C, Verheye S, Vermeersch P, Agostoni P, Zivelonghi C. Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature. Catheter Cardiovasc Interv 2023. [PMID: 37210617 DOI: 10.1002/ccd.30693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023]
Abstract
Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary intervention (PCI) may represent an effective treatment to avoid prolonged myocardial ischemia. To evaluate feasibility and efficacy of PCI treatment, all records of LCx injury related to mitral valve surgery and treated with PCI were included after a systematic PubMed searching. Moreover, we retrospectively analyzed our single-center PCI database and patients fulfilling the inclusion criteria were included. Patients undergoing transcatheter mitral valve intervention, non-mitral valve surgery, conservatively or surgically treated after LCx injury were excluded. Data about patient characteristics, procedural details, PCI success, and in-hospital mortality were collected. Fifty-six patients were included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR = 21.75). The majority had left dominant or codominant coronary system (62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG, 23.5% of patients (n = 12) presented ST-segment depression, 58.8% (n = 30) ST-segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n = 15) ventricular arrhythmias. Left ventricle dysfunction was present in 52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n = 30). PCI success rate was 82.1% (n = 46) and in-hospital mortality 4.5% (n = 2). LCx injury related to mitral surgery is a rare complication characterized by an increased risk of mortality. PCI seems a feasible treatment option, still burdened by suboptimal results, probably related to the technical challenges posed by the surgical failure.
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Affiliation(s)
- Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Benedetti A, Castaldi G, Vermeersch P, Wilgenhof A, Convens C, Scott B, Verheye S, Agostoni P, Zivelonghi C. Clinical implications of coronary microvascular dysfunction in patients with non-obstructive coronary artery disease and role of the thermodilution method. Minerva Cardiol Angiol 2023:S2724-5683.23.06289-0. [PMID: 36939733 DOI: 10.23736/s2724-5683.23.06289-0] [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: 03/21/2023]
Abstract
More than 60% of patients undergoing coronary angiography present no coronary artery disease (CAD). Angina and myocardial ischemia are classically determined by epicardial vascular obstruction, but coronary microvascular dysfunction (CMD) may also represent a possible cause for these phenomena. Two endotypes of CMD have been recognized, with two different pathophysiological mechanisms: structural CMD, characterized by low coronary flow reserve (CFR) and high microvascular resistance (MVR) values; and functional CMD, characterized by low CFR and normal MVR values. According to the present data, almost half of patients with non-obstructive CAD have shown signs of CMD. For this reason, further investigations for microvascular function assessment should be considered when evaluating no-CAD patients complaining of angina or presenting signs of myocardial ischemia. The thermodilution method is currently becoming a widespread invasive technique due to its feasibility and high reproducibility for coronary physiology evaluation. Furthermore, a recently introduced technique - called continuous thermodilution - allows for direct measurement of absolute coronary flow and resistances. The role of this brand-new technique in the clinical scenario is however still to be fully investigated and its use is at present limited to research purposes only. Among no-CAD patients, both structural and functional CMD are related to a worse prognosis in term of mortality and major adverse cardiovascular events (MACE). In this review, we will discuss the present evidence supporting the definition, prevalence and clinical implication of the different forms of CMD and the technical aspects of its invasive assessment.
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Affiliation(s)
- Alice Benedetti
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium
| | | | - Carlo Zivelonghi
- HartCentrum, Antwerpen Hospital Network (ZNA) Middelheim, Antwerp, Belgium -
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8
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Castaldi G, Benedetti A, Zivelonghi C, Scott B, Wilgenhof A, Convens C, Verheye S, Vermeersch P, Agostoni P. A glimpse into the future of the percutaneous treatment of coronary chronic total occlusions. Minerva Cardiol Angiol 2023:S2724-5683.23.06293-2. [PMID: 36912168 DOI: 10.23736/s2724-5683.23.06293-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Percutaneous coronary intervention (PCI) of coronary chronic total occlusion (CTO PCI) is one of the most challenging but rewarding procedures in the portfolio of interventional cardiologists. Several challenges, however, still must be overcome and many questions need to be answered. After coronary artery bypass graft (CABG), disease of the conduits and concomitant progression of atherosclerotic disease to CTO of the subtended native coronary vessels are common and associated with onset of new anginal symptoms and worsening of the prognosis. Which is the best strategy for these post-CABG CTOs? Furthermore, what is the role of physiology in the setting of CTO PCI? In the last decades, many researchers tried to demystify the complex maze but technical limitations and the demanding procedure itself, for both the patient and the operator, do not allow extensive investigation of its impact on clinical practice. Can we enhance periprocedural planning of CTO PCI with a more tailored and multidimensional evaluation? Analysis of coronary computed tomography angiography (CCTA) scans is getting more and more incorporated into the clinical routine and training of interventional cardiologists but mainly focuses on structural valvular disease. Nevertheless, with the appropriate expertise, a lot of information can be derived for coronary intervention to improve procedural planning and potentially outcomes. Finally, in the era of drug-eluting stent, is there a place for strategies that minimize metal implantation in the coronaries to further reduce late-onset adverse events in CTO PCI? This approach could be attractive in CTOs due to the higher risk of target vessel failure and revascularization shown in literature but, at the same time, more challenging due to the histological and anatomical complexity of the disease. In this review, we aim to tackle these questions and concomitantly provide a vision of potential future application of new techniques and technology in CTO PCI that could allow further advancement in this field.
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Affiliation(s)
- Gianluca Castaldi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Convens
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
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Vescovo GM, Somov P, Zivelonghi C, Bezzeccheri A, Scott B, Wilgenhof A, Willemen Y, Convens C, Verheye S, Vermeersch P, Agostoni P. Feasibility, safety and predictors of a successful "blind wiring" antegrade approach in the percutaneous treatment of chronic coronary total occlusions. Minerva Cardiol Angiol 2023; 71:61-69. [PMID: 35212513 DOI: 10.23736/s2724-5683.22.05978-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Antegrade wiring using only antegrade guiding catheter without contralateral injection (defined as "blind antegrade wiring") may represent a valid initial treatment strategy for selected chronic coronary total occlusions (CTOs) due to the potentially lower risk of vascular complications. A careful selection of lesions eligible for this strategy as well as an accurate balance between the likelihood of success and failure is paramount. The aim of the study is to determine the rate of successful revascularization, the potential predictors of failure and the incidence of major complications, when using a "blind antegrade wiring" technique. METHODS In this multicentric study, consecutive patients with CTO undergoing percutaneous coronary intervention (PCI) were retrospectively screened. All cases approached using "blind antegrade wiring" technique were included. RESULTS Out of 155 consecutive CTO-PCIs, 94 involved initial "blind antegrade wiring" strategy. Successful revascularization by means of "blind antegrade wiring" technique was achieved in 73 (78%) patients. Final successful revascularization was obtained in 19 of the remaining 21 procedures with "blind antegrade wiring" failure using other techniques (by adding a second contralateral guiding catheter; 98% total successful revascularization). Logistic regression analysis identified higher J-CTO Score as the only predictor of "blind antegrade wiring" failure. One complication occurred (wire-based coronary perforation). CONCLUSIONS "Blind antegrade wiring" may be considered as initial strategy for selected CTO-PCI, mainly for CTOs with low J-CTO Score. This strategy would allow in a substantial number of cases to avoid a priori dual injection, keeping it as secondary strategy in case of "blind antegrade wiring" failure.
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Affiliation(s)
| | - Pavel Somov
- Pirogov's National Medical Surgical Center, Moscow, Russia
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium.,Department of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | | | - Yannick Willemen
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
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Bezzeccheri A, Vermeersch P, Verheye S, Wilgenhof A, Willemen Y, Vescovo GM, Scott B, Convens C, Zivelonghi C, Agostoni P. Trends and outcomes in transcatheter aortic valve implantation in Belgium: a 13-year single centre experience. Acta Cardiol 2022; 77:960-969. [PMID: 36326198 DOI: 10.1080/00015385.2022.2130444] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been adopted as an alternative to surgery in severe aortic stenosis treatment, even in low-intermediate risk. The aim of this study is to retrospectively report our single-centre 13-year TAVI experience with emphasis on learning curve, referral indication and trends in outcomes over time. METHODS We included 361 consecutive patients who underwent TAVI from January 2008 to December 2020, grouped according to similar per-year volume of procedures: G1 (2008-2014), G2 (2015-2017) and G3 (2018-2020). RESULTS The number of procedures increased (group size: 59 vs. 106 vs. 196). No major differences were observed in STS-PROM and EuroSCORE-II between groups, despite TAVI in patients with prior surgical revascularisation was mainly performed in G1. Trans-femoral approach raised from 80.8 to 93.4%, while the most common alternative access was trans-subclavian. The pre-dilation rate was higher in G1 with lower prosthesis post-dilation rate. The length of hospital stay decreased in time by 30%. At 30 days a reduction in all-cause mortality, vascular complications, bleedings and para-valvular leak combined with higher rate of permanent pacing were observed over the groups. At 1-year there was no difference in all-cause mortality but over 30% reduction in cardiovascular death (8.5 vs. 7.5 vs. 5.6%). CONCLUSIONS Favourable trends were observed across the groups, with an improvement in periprocedural outcomes and cardiovascular mortality at 1-year. These improvements could depend on increased expertise because mortality reduction was noted only after reaching a significant procedure volume. A trend towards lower risk patients selection was present in our cohort, as previously described worldwide.
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Affiliation(s)
- Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Yannick Willemen
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Benedetti A, Wilgenhof A, Castaldi G, Bezzeccheri A, Vescovo GM, Agostoni P, Convens C, Scott B, Verheye S, Vermeersch P, De Keulenaer G, Zivelonghi C. TCT-293 Invasive Assessment of Coronary Microvascular Dysfunction in Patients With Arrhythmia-Induced Cardiomyopathy. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.345] [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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Wilgenhof A, Vescovo GM, Bezzeccheri A, Scott B, Vermeersch P, Convens C, Verheye S, Zivelonghi C, Agostoni P. Minimalistic hybrid approach for the percutaneous treatment of chronic coronary total occlusions: An in-depth analysis of the whole algorithm. Catheter Cardiovasc Interv 2022; 100:502-511. [PMID: 35900200 DOI: 10.1002/ccd.30352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/08/2022] [Revised: 06/06/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The minimalistic hybrid approach (MHA) is an algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The current study aims to evaluate the distribution of patients among the five different treatment strategies, the different techniques used in each strategy, the overall procedural success, and the safety of the MHA algorithm. METHODS Data from a consecutive series of patients with a CTO who underwent elective PCI between February 2019 and July 2021 were prospectively collected and retrospectively analyzed. RESULTS One hundred and forty-three CTOPCI in 135 patients were approached according to the MHA algorithm: 134 CTO (93.7%) were successfully recanalized and 9 procedures failed. About half of the procedures (48.3%) were approached using strategy A: antegrade "blind wiring" with contralateral retrograde options, making this the most popular strategy. A total of 89 procedures (62.2%) were completed with a single guiding catheter; in 86 (96.6%) a forearm approach was used. The remaining 54 cases were performed with dual access; in the majority of these patients (90.7%), a bilateral forearm approach was used. The only reason to use the femoral access was inadequate forearm access. One hundred and fifty-four out of 197 (78.2%) access sites were 6 French sheaths. CONCLUSION MHA is a stepwise approach focused on the forearm approach to reduce the number of access sites and catheter size used in CTOPCI while maintaining proficiency and safety. Operators should be warned that this approach should be adopted only by experienced CTO operators who master all the strategies of the classic hybrid algorithm and the forearm approach.
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Affiliation(s)
- Adriaan Wilgenhof
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Giovanni Maria Vescovo
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Vescovo GM, Chiabrando JG, Zivelonghi C, Romeo FJ, Lombardi M, Del Buono MG, Galli M, Biondi-Zoccai G, Wilgenhof A, Willemen Y, Scott B, Convens C, Verheye S, Vermeersch P, Agostoni P. Comparison of Different Stenting Techniques in Left Main Bifurcation Disease: Evidence From a Network Meta-Analysis. J Invasive Cardiol 2022; 34:E334-E342. [PMID: 35366228 DOI: pmid/35366228] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We aimed to assess which bifurcation technique performs best in unprotected left-main (LM) percutaneous coronary intervention (PCI). BACKGROUND Provisional stenting was considered the preferred technique for LM bifurcation PCI due to the supposed lower risks of thrombosis and restenosis. However, recent studies showed potential advantages of double kissing (DK)-crush technique over the other strategies. METHODS We performed a frequentist network meta-analysis comparing different stenting techniques in the setting of LM bifurcation. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched. Both randomized clinical trials and non-randomized clinical trials were considered eligible for inclusion. Incidence rate ratios (IRRs) were computed using a random-effects model for death, cardiac death, myocardial infarction, target-vessel revascularization, target-lesion revascularization, and stent thrombosis, including 95% confidence intervals (CIs). RESULTS A total of 10 studies (2364 patients) were included. Compared with provisional stenting, DK-crush was associated with fewer cardiac deaths (IRR, 0.34; 95% CI, 0.17-0.70; P<.01), myocardial infarctions (IRR, 0.19; 95% CI, 0.08-0.44; P<.001), stent thromboses (IRR, 0.31; 95% CI, 0.14-0.69; P<.01), target-vessel revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001), and target-lesion revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001). DK-crush was also associated with a lower risk of myocardial infarction (IRR, 0.19; 95% CI, 0.05-0.76; P=.02) when compared with standard crush and lower risk of target-lesion revascularization when compared with culotte (IRR, 0.32; 95% CI, 0.12-0.83; P=.02) and crush (IRR, 0.07; 95% CI, 0.02-0.28; P<.001). CONCLUSIONS DK-crush is the best technique for unprotected LM bifurcation PCI.
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Affiliation(s)
- Giovanni Maria Vescovo
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
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De Roeck F, Scott B, Convens C, Vermeersch P. Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study. Acta Cardiol 2021; 76:727-731. [PMID: 32552543 DOI: 10.1080/00015385.2020.1778373] [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: 10/24/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS), rapidly gaining recognition over the last decade. SCAD occurs predominantly in young, otherwise healthy women and coronary angiogram often lacks typical (atherosclerotic) features. Therefore, SCAD remains notably underdiagnosed. As optimal treatment strategy differs greatly from atherosclerotic ACS, early (differential) diagnosis is crucial. PURPOSE/METHODS In this paper, all coronary angiograms performed for ACS in women up to 50 years of age were retrospectively reviewed by three independent interventional cardiologists. RESULTS The obtained insights are comparable to recent literature. SCAD incidence was 26% in this cohort. Left anterior descending coronary artery was the main affected vessel with SCAD subtype 2B as predominant angiographic presentation. Correct diagnosis during index procedure was poor with only 33% accuracy. Nevertheless, a favourable trend over time was noted. Percutaneous coronary intervention success was 56%, as in 44% of patients initial stenting was complicated by progressive dissection. Overall, outcome was excellent with no reported fatalities. CONCLUSION SCAD remains an underdiagnosed subtype of ACS and the importance of increasing awareness amongst (interventional) cardiologists needs to be emphasised.
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Affiliation(s)
- Frederic De Roeck
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Carl Convens
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
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15
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Wilgenhof A, Zivelonghi C, Verheye S, Vermeersch P, Scott B, Convens C, Timmers L, Leenders G, Kuijk JPV, Stella P, Agostoni P. Coronary sinus anatomical features: Description and procedural implications during coronary sinus Reducer implantation. Catheter Cardiovasc Interv 2021; 97:E929-E935. [PMID: 33211373 DOI: 10.1002/ccd.29398] [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: 06/10/2020] [Revised: 10/14/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We hypothesized that some coronary sinus (CS) anatomies allow a more straightforward CS Reducer (CSR) implantation. BACKGROUND Recent decades have seen a rise in patients with chronic angina. When complete revascularization and maximal medical therapy fail to reduce symptoms, CSR has become a new therapeutic option. METHODS We identified a classical C-shape-a near horizontal course of the proximal portion of a circular CS-in a retrospective analysis of 47 CSR implantations and compared the procedural time, fluoroscopic time, contrast use, presence of valves or bifurcations and procedural complications with the non-C-shape CS anatomy. RESULTS We found a significant difference in procedural (20.0 [19.0-24.7] min vs. 24.5 [20.7-51.0] min; p = .028 and fluoroscopic time (9.5 [7.5-14.5] min vs. 11.0 [7.9-30.0] min; p = .016). There was no significant difference in contrast use. The presence of bifurcations or valves along the CS course did not influence the procedural timings. CONCLUSION This study is the first systematic evaluation of CS anatomy and its procedural implications. We identified a favorable C-shape anatomy which allows for a more straightforward implantation. Operators should be aware of the different implications of CS anatomy, their influence on guiding catheter stability and overall procedure complexity.
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Affiliation(s)
- Adriaan Wilgenhof
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Leo Timmers
- Cardiology Department, Sint Antonius hospital, Nieuwegein, The Netherlands
| | - Geert Leenders
- Cardiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter Stella
- Cardiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
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Agostoni P, Scott B, Budassi S, Verheye S, Convens C, Vermeersch P, Zivelonghi C. A prospective evaluation of a redefined version of the "minimalistic hybrid approach" algorithm for percutaneous coronary chronic total occlusion revascularization. Catheter Cardiovasc Interv 2020; 98:617-625. [PMID: 32755018 DOI: 10.1002/ccd.29158] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Aim of this study is to prospectively assess the feasibility of the "Minimalistic Hybrid Approach" (MHA) algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND We recently described the MHA, with focus on the classic hybrid strategies (antegrade wire escalation [AWE] or retrograde wire escalation [RWE], antegrade dissection-re-entry [ADR] or retrograde dissection-re-entry [RDR]), and also on access site (favoring "wrist" approach: radial, ulnar, and distal radial), introducer French size (favoring 6 French catheters) and nonroutine initial use of dual injection. METHODS The MHA was prospectively attempted in 56 consecutive CTO PCI in 54 patients. Technical success was defined as the achievement of TIMI 3 antegrade flow with residual stenosis <30%, procedural success was defined as technical success without in-hospital major adverse cardiovascular events. RESULTS Mean Japanese-CTO (J-CTO) score was 2.04 ± 0.95(J-CTO score ≥ 3 in 30.4%). The lesion-based technical and procedural success were 94.6%(53/56:three failures, two in the same patient) and 91.1%(51/56:three failures, one tamponade requiring pericardiocentesis and one periprocedural infarction), the patient-based successes were: technical 98.1%(53/54) and procedural 94.4%(51/54). In 34 procedures (60.7%), the approach was single catheter (always trans-wrist besides one femoral). Out of the 22(39.3%) lesions approached with dual catheters, one was bi-femoral, the rest was bi-wrist. In 29 cases (51.8%) AWE represented the successful technique, ADR in 5(8.9%) and retrograde in 19(33.9%); 3(5.4%) were failures. CONCLUSIONS The current study shows that the MHA algorithm is feasible in almost every CTO lesion and it can lead to extremely successful results once applied by operators well acquainted with the wrist approach and with established experience using the full spectrum of the hybrid algorithm techniques.
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Affiliation(s)
| | - Benjamin Scott
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Simone Budassi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Degrauwe S, Azzano A, Iglesias JF, Zivelonghi C, Verheye S, Convens C, Vermeersch P, Scott B. Intracoronary adenosine-induced torsades de pointes during fractional flow reserve measurement. Cardiol J 2019; 26:612-613. [PMID: 31701514 DOI: 10.5603/cj.2019.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sophie Degrauwe
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland.
| | - Alessia Azzano
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland
| | - Carlo Zivelonghi
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
| | - Stefan Verheye
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
| | - Carl Convens
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
| | - Paul Vermeersch
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
| | - Benjamin Scott
- Department of Cardiology, ZNA Middelheim, Antwerp, Belgium, Lindendreef 1, 2000 Antwerpen
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Salah M, Gevaert S, Coussement P, Beauloye C, Sinnaeve PR, Convens C, De Raedt H, Dens J, Pourbaix S, Saenen J, Claeys MJ. Vulnerability to cardiac arrest in patients with ST elevation myocardial infarction: Is it time or patient dependent? Results from a nationwide observational study. Eur Heart J Acute Cardiovasc Care 2019; 9:S153-S160. [PMID: 31452398 DOI: 10.1177/2048872619872127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Cardiac arrest is a common complication of ST elevation myocardial infarction and is associated with high mortality. We evaluated whether vulnerability to cardiac arrest follows a circadian rhythm and whether it is related to specific patient characteristics. METHODS A total of 24,164 ST elevation myocardial infarction patients who were admitted to 60 Belgian hospitals between 2008-2017 were analysed. The proportion of patients with cardiac arrest before initiation of reperfusion therapy was calculated for different time periods (hour of the day, months, seasons) and related to patient characteristics using stepwise logistic regression analysis. RESULTS Cardiac arrest occurred in 10.8% of the ST elevation myocardial infarction patients at a median of 65 min (interquartile range 33-138 min) after onset of pain. ST elevation myocardial infarction patients with cardiac arrest showed a biphasic pattern with one peak in the morning and one peak in the late afternoon. Multivariate analysis identified the following independent factors associated with cardiac arrest: cardiogenic shock (odds ratio=28), left bundle branch block (odds ratio=3.7), short (<180 min) ischaemic period (odds ratio=2.2), post-meridiem daytime presentation (odds ratio=1.4), anterior infarction (odds ratio=1.3). Overall in-hospital mortality was 30% for cardiac arrest patients versus 3.7% for non-cardiac arrest patients (p<0.0001). CONCLUSION In the present study population, cardiac arrest in ST elevation myocardial infarction showed an atypical circadian rhythm with not only a morning peak but also a second peak in the late afternoon, suggesting that cardiac arrest and ST elevation myocardial infarction triggers are, at least partially, different. In addition, specific patient characteristics, such as short ischaemic period, cardiogenic shock and left bundle branch block, increase the vulnerability to cardiac arrest.
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Affiliation(s)
- Mahadi Salah
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Belgium
| | | | | | | | - Carl Convens
- Department of Cardiology, ZNA Antwerpen, Belgium
| | | | - Jo Dens
- Department of Cardiology, ZOL Genk, Belgium
| | | | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Belgium
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Rosseel L, Scott B, Prihadi E, Azzano A, Degrauwe S, Verheye S, Convens C, Vermeersch P. Is a covered stent justifiable in the treatment of coronary artery perforation? An observational analysis of long-term results of two different covered stent types. Catheter Cardiovasc Interv 2018; 93:419-425. [PMID: 30280487 DOI: 10.1002/ccd.27892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/03/2018] [Accepted: 08/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In this retrospective observational study, we investigate outcome of patients treated with or without covered stent (CS) implantation in the management of coronary artery perforation (CAP) during coronary intervention. BACKGROUND CSs have shown to be effective devices to achieve acute hemostasis in large CAP. However, doubts have been raised regarding their long-term outcome. METHODS Data of 19 061 PCI procedures during a 10-year period were reviewed. Fifty-five cases of large CAP were withheld (Ellis type 2, 3 or cavity spilling). All medical and procedural records of these cases were retrospectively reviewed. RESULTS Twenty-four (43.6%) patients were treated with CS implantation (15 polytetrafluoroethylene and 9 pericardium CSs). Twenty-six (47.3%) patients were managed without CS implantation, of whom five had unsuccessful delivery of a CS (stent delivery failure 17.2%). Although significantly more Ellis type-3 perforations were present in the CS group compared to the Non-CS group (75.0% vs 45.2%; P = 0.03), in-hospital mortality was not significantly different (8.3% vs 6.4%; [P = 0.79]). We observed a high rate of CS restenosis (29.2%) but a lower rate of CS thrombosis (4.2%). Despite these observations, 5-year MACE and all-cause mortality were not significantly different between CS and Non-CS group (respectively, 58.8% vs 50.0% (P = 0.26) and 26.7% vs 13.3% (P = 0.36)). CONCLUSION Although deliverability of CSs was not flawless and a high rate of CS restenosis appeared, short- and long-term outcome were comparable between patients treated with or without CS. Therefore, CSs are justifiable in the treatment of CAP.
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De Roeck F, Scott B, Convens C, Vermeersch P. P1569Spontaneous coronary artery dissection in young female acute coronary syndrome patients; a single-centre retrospective data analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1569] [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: 11/13/2022] Open
Affiliation(s)
- F De Roeck
- ZNA Middelheim Hospital, ZNA Hartcentrum - Department of Cardiology, Antwerp, Belgium
| | - B Scott
- ZNA Middelheim Hospital, ZNA Hartcentrum - Department of Cardiology, Antwerp, Belgium
| | - C Convens
- ZNA Middelheim Hospital, ZNA Hartcentrum - Department of Cardiology, Antwerp, Belgium
| | - P Vermeersch
- ZNA Middelheim Hospital, ZNA Hartcentrum - Department of Cardiology, Antwerp, Belgium
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Salah M, Gevaert S, Coussement P, Beauloye C, Sinnaeve P, Convens C, De Raedt H, Dens J, Saenen J, Claeys MJ. 468Vulnerability for cardiac arrest in patients with ST elevation myocardial infarction: Is it time or patient dependent? Results from a nationwide observational study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.468] [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: 11/13/2022] Open
Affiliation(s)
- M Salah
- University of Antwerp Hospital, Antwerp, Belgium
| | - S Gevaert
- Ghent University Hospital (UZ), Ghent, Belgium
| | | | - C Beauloye
- Catholic University of Louvain (UCL), Leuven, Belgium
| | - P Sinnaeve
- University Hospital Leuven, Leuven, Belgium
| | - C Convens
- ZNA Middelheim Hospital, Antwerp, Belgium
| | - H De Raedt
- Cardiovascular Center Aalst, Aalst, Belgium
| | - J Dens
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | - J Saenen
- University of Antwerp Hospital, Antwerp, Belgium
| | - M J Claeys
- University of Antwerp Hospital, Antwerp, Belgium
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Claeys MJ, Sinnaeve PR, Convens C, Dubois P, Pourbaix S, Vranckx P, Gevaert S, De Raedt H, Beauloye C, Argacha JF, Evrard P, Coussement P. Quality assessment in Belgian ST elevation myocardial infarction patients: results from the Belgian STEMI database. Acta Cardiol 2017; 73:1-5. [PMID: 29228878 DOI: 10.1080/00015385.2017.1414344] [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: 10/24/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
The present report describes the quality of care, including in hospital mortality for more than 22.000 STEMI patients admitted in 60 Belgian hospitals for the period 2008-2016. We found a strong increase in the use of primary PCI over time, particularly for patients that were admitted first in a non-PCI capable hospital, reaching a penetration rate of >95%. The transition of thrombolysis to transfer for pPCI in the setting of a STEMI network was, however, associated with an increase of the proportion of patients with prolonged (>120 min) diagnosis-to-balloon time (from 16 to 22%), suggesting still suboptimal interhospital transfer. The in-hospital mortality of the total study population was 6.5%. For non-cardiac arrest patients in-hospital mortality decreased from 5.1% to 3.7%, while it increased for cardiac arrest patients from 29 to 37%. The observation that quality indicators (QI's), such as modalities and timing of reperfusion therapy, were associated with lower levels of mortality, underscores the potential of QIs for STEMI to improve care and reduce unwarranted variation and premature death from STEMI.
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Affiliation(s)
- Marc J Claeys
- a Department of Cardiology, University Hospital Antwerp , Edegem , Belgium
| | | | - Carl Convens
- c Department of Cardiology, ZNA Antwerpen , Antwerp , Belgium
| | - Philippe Dubois
- d Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | - Suzanne Pourbaix
- e Department of Cardiology, CHR Citadelle Liège , Liège , Belgium
| | - Pascal Vranckx
- f Department of Cardiology, Virga Jesse Hasselt , Hasselt , Belgium
| | - Sofie Gevaert
- g Department of Cardiology, UZ Gent , Gent , Belgium
| | - Herbert De Raedt
- h Department of Cardiology, OLV Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Patrick Evrard
- k Department of Cardiology, UCL Mont-Godinne , Yvoir , Belgium
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Gevaert SA, De Bacquer D, Evrard P, Convens C, Dubois P, Boland J, Renard M, Beauloye C, Coussement P, De Raedt H, de Meester A, Vandecasteele E, Vranckx P, Sinnaeve PR, Claeys MJ. Gender, TIMI risk score and in-hospital mortality in STEMI patients undergoing primary PCI: results from the Belgian STEMI registry. EUROINTERVENTION 2014; 9:1095-101. [PMID: 24457280 DOI: 10.4244/eijv9i9a184] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. METHODS AND RESULTS In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was 10.1% in women vs. 4.9% in men (OR 2.2; 95% CI: 1.82-2.66, p<0.001). When adjusting for TIMI risk score variables, mortality remained higher in women (OR 1.47, 95% CI: 1.15-1.87, p=0.002). The TIMI risk score provided a good predictive discrimination and calibration in women as well as in men (c-statistic=0.84 [95% CI: 0.809-0.866], goodness-of-fit p=0.53 and c-statistic=0.89 [95% CI: 0.873-0.907], goodness-of-fit p=0.13, respectively), but mortality prediction for TIMI scores was better in men (p=0.02 for TIMI score x gender interaction). CONCLUSIONS In the Belgian STEMI registry, pPCI-treated women had a higher in-hospital mortality rate even after correcting for TIMI risk score variables. The TIMI risk score was effective in predicting in-hospital mortality but performed slightly better in men. The database was registered with clinicaltrials.gov (NCT00727623).
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Affiliation(s)
- Sofie A Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Claeys MJ, Sinnaeve PR, Convens C, Dubois P, Boland J, Vranckx P, Gevaert S, de Meester A, Coussement P, De Raedt H, Beauloye C, Renard M, Vrints C, Evrard P. STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network programme. Eur Heart J Acute Cardiovasc Care 2013; 1:40-7. [PMID: 24062886 DOI: 10.1177/2048872612441579] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 01/30/2012] [Indexed: 12/28/2022]
Abstract
AIMS Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a real-world context, more data are needed on management and outcome of an unselected community based STEMI population. METHODS AND RESULTS The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n=3053) and 25 PCI-capable hospitals (n=5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCI-capable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time <120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p<0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%. CONCLUSION In a STEMI network with >70% use of pPCI, in-hospital mortality was comparable between community hospitals and PCI-capable hospitals. Participation in the STEMI network programme was associated with an increased adherence to reperfusion guidelines over time.
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Claeys MJ, Sinnaeve PR, Convens C, Dubois P, Boland J, Vranckx P, Gevaert S, Coussement P, Beauloye C, Renard M, Vrints C, Evrard P. Inter-hospital variation in length of hospital stay after ST-elevation myocardial infarction: results from the Belgian STEMI registry. Acta Cardiol 2013; 68:235-9. [PMID: 23882867 DOI: 10.1080/ac.68.3.2983416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this paper was to assess the determinants of and variations in length of hospital stay (LOS) in Belgium after ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Data on LOS were collected from 2079 STEMI patients who were discharged alive from 33 Belgian hospitals (21 with PCI facilities) during 2010-201 1. Early discharge was defined as hospital discharge within 4 days after admission, and the hospitals were clustered according to their LOS for low-risk patients. Determinants of LOS were calculated by means of a negative binomial regression model. LOS was, on average, 6.5 days with a median of 5 days (IQR 4). Baseline risk profiles and reperfusion treatment explained only 13% of the LOS variation. Additional analysis revealed major in-hospital variations independent of the case mix of patients. For comparable baseline risk profiles, the average LOS in a cluster of 11 hospitals with short discharge policies was 5.3 + 5.6 days, with an early discharge rate of 58%, while in the cluster of 11 hospitals with long discharge policies, the average LOS was 7.9 + 8.5 days with an early discharge rate of 22% (P <0.0001). Among the clustered hospitals, there were no differences with regard to logistics (PCI facility, academic affiliation) or volume of STEMI patients. The 1-month mortality rate was less than 0.5% in the different clusters of hospitals (p = NS). CONCLUSIONS Length of hospital stay is not only determined by baseline risk profiles of patients but is also highly dependent on hospital discharge policy, which seems to be unrelated to medical or logistical factors.
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Claeys MJ, de Meester A, Convens C, Dubois P, Boland J, De Raedt H, Vranckx P, Coussement P, Gevaert S, Sinnaeve P, Evrard P, Beauloye C, Renard M, Vrints C. Contemporary mortality differences between primary percutaneous coronary intervention and thrombolysis in ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2011; 171:544-9. [PMID: 21444843 DOI: 10.1001/archinternmed.2011.57] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Current ST-segment elevation myocardial infarction guidelines regarding reperfusion strategy are based on trials conducted before the application of routine invasive evaluation after thrombolysis. Modern thrombolysis may affect the previously observed mortality difference between primary percutaneous coronary intervention (PPCI) and thrombolysis. METHODS In-hospital mortality was prospectively assessed in 5295 patients with ST-segment elevation myocardial infarction admitted to 73 Belgian hospitals from July 1, 2007, through December 31, 2009. A total of 4574 patients (86.4%) were treated with PPCI and 721 (13.6%) received thrombolysis; of these thrombolysis patients, 603 (83.6%) underwent subsequent invasive evaluation. The Thrombolysis in Myocardial Infarction risk score was used to stratify the study population by low (n = 1934), intermediate (n = 2382), and high (n = 979) risk. RESULTS In-hospital mortality in the PPCI patients was 5.9% vs 6.6% in the thrombolysis patients. After adjustment for differences in baseline risk profile, a significant mortality benefit was only present in the high-risk groups: 23.7% in the PPCI patients vs 30.6% in the thrombolysis patients. For patients not at high risk, the mortality difference was marginal. For low-risk patients, mortality was 0.3% in the PPCI patients vs 0.4% in the thrombolysis patients. For intermediate-risk patients, mortality was 2.9% in the PPCI patients vs 3.1% in the thrombolysis patients. Subgroup analysis revealed that the mortality benefit of PPCI compared with early thrombolysis (door-to-needle time <30 minutes) was offset if the door-to-balloon time exceeded 60 minutes. CONCLUSIONS Modern thrombolytic strategies have substantially attenuated the absolute mortality benefit of PPCI over thrombolysis, particularly in patients not at high risk. Our study findings suggest that target door-to-balloon time should be less than 60 minutes to maintain the lowest mortality rates.
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Affiliation(s)
- Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Wilrijkstr 10 2650 Edegem, Belgium.
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Langenhove GV, Vermeersch P, Verheye S, Benit E, Vrolix M, De Smet W, Van den Heuvel P, Convens C, Van den Branden F. BIOABSORBABLE OIL COATED DRUG RELEASING STENTS: FIM EXPERIENCE. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61091-7] [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: 10/18/2022]
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Almafragi A, Convens C, Heuvel PVD. Spontaneous healing of spontaneous coronary artery dissection. Cardiol J 2010; 17:92-95. [PMID: 20104464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.
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Affiliation(s)
- Amar Almafragi
- Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium.
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Semeraro O, Agostoni P, Verheye S, Van Langenhove G, Van den Heuvel P, Convens C, Van den Branden F, Bruining N, Vermeersch P. Re-examining minimal luminal diameter relocation and quantitative coronary angiography--intravascular ultrasound correlations in stented saphenous vein grafts: methodological insights from the randomised RRISC trial. EUROINTERVENTION 2009; 4:633-40. [PMID: 19378685 DOI: 10.4244/eijv4i5a106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Angiographic parameters (such as late luminal loss) are common endpoints in drug-eluting stent trials, but their correlation with the neointimal process and their reliability in predicting restenosis are debated. METHODS AND RESULTS Using quantitative coronary angiography (QCA) data (49 bare metal stent and 44 sirolimus-eluting stent lesions) and intravascular ultrasound (IVUS) data (39 bare metal stent and 34 sirolimus-eluting stent lesions) from the randomised Reduction of Restenosis In Saphenous vein grafts with Cypher stent (RRISC) trial, we analysed the "relocation phenomenon" of QCA-based in-stent minimal luminal diameter (MLD) between post-procedure and follow-up and we correlated QCA-based and IVUS-based restenotic parameters in stented saphenous vein grafts. We expected the presence of MLD relocation for low late loss values, as MLD can "migrate" along the stent if minimal re-narrowing occurs, while we anticipated follow-up MLD to be located close to post-procedural MLD position for higher late loss. QCA-based MLD relocation occurred frequently: the site of MLD shifted from post-procedure to follow-up an "absolute" distance of 5.8 mm [2.5-10.2] and a "relative" value of 29% [10-46]. MLD relocation failed to correlate with in-stent late loss (rho = 0.14 for "absolute" MLD relocation [p = 0.17], and rho=0.03 for "relative" relocation [p = 0.811). Follow-up QCA-based and IVUS-based MLD values well correlated in the overall population (rho = 0.76, p < 0.001), but QCA underestimated MLD on average 0.55 +/- 0.49 mm, and this was mainly evident for lower MLD values. Conversely, the location of QCA-based MLD failed to correlate with the location of IVUS-based MLD (rho = 0.01 for "absolute" values--in mm [p = 0.911, rho = 0.19 for "relative" values--in % [p = 0.111). Overall, the ability of late loss to "predict" IVUS parameters of restenosis (maximum neointimal hyperplasia diameter, neointimal hyperplasia index and maximum neointimal hyperplasia area) was moderate (rho between 0.46 and 0.54 for the 3 IVUS parameters). CONCLUSIONS These findings suggest the need for a critical re-evaluation of angiographic parameters (such as late loss) as endpoints for drug-eluting stent trials and the use of more precise techniques to describe accurately and properly the restenotic process.
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Affiliation(s)
- Oscar Semeraro
- Antwerp Cardiovascular Institute Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
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Van Assche A, Vermeersch P, Convens C. Superior vena cava syndrome: a rare complication of saphenous vein graft stenting: a case report. Int J Cardiol 2008; 128:e111-2. [PMID: 17707528 DOI: 10.1016/j.ijcard.2007.05.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 05/26/2007] [Indexed: 11/20/2022]
Abstract
Rupture of coronary artery bypass graft during percutaneous coronary intervention is a rare but serious complication. These perforations are often associated with myocardial infarction, pericardial tamponade, immediate or delayed, emergency bypass surgery and even death. We report an interesting case where perforation of a saphenous vein graft occurred after direct stenting, resulting in a very rare complication of superior vena cava (SVC) syndrome.
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Agostoni P, Biondi-Zoccai G, Van Langenhove G, Cornelis K, Vermeersch P, Convens C, Vassanelli C, Van Den Heuvel P, Van Den Branden F, Verheye S. Comparison of assessment of native coronary arteries by standard versus three-dimensional coronary angiography. Am J Cardiol 2008; 102:272-9. [PMID: 18638585 DOI: 10.1016/j.amjcard.2008.03.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 03/11/2008] [Accepted: 03/11/2008] [Indexed: 02/08/2023]
Abstract
Vessel foreshortening is a major limitation of standard coronary angiography due to the 2-dimensional representation of 3-dimensional structures. Three-dimensional models may overcome it. The aim of this study was to compare measurements of coronary segments from quantitative coronary angiography (QCA) in an operator-selected "working view" of standard 2-dimensional coronary angiography with those from 3-dimensional coronary angiography (3D-CA) reconstruction models, which are automatically generated from software applied to rotational coronary angiographic acquisitions. Patients who underwent percutaneous coronary intervention were considered. Two or 3 segments of the artery needing treatment were prespecified, using bifurcations as edges. The operator selected a working view from standard angiography as the view best representing each segment. Rotational angiography was performed, allowing 3-dimensional reconstruction of the selected segments. Additionally a marker guidewire (with 4 markers 10 mm away from one another at the distal tip) was used to further measure segment length, and it was considered the "gold standard" reference. In 36 patients, 81 segments from 12 left anterior descending, 12 circumflex, and 12 right coronary arteries were evaluated. Three-dimensional coronary angiography was always feasible. Although reference vessel diameter was not different between 3D-CA and QCA (p >0.05), segment length measurements were on average 2.3 +/- 2.5 mm longer with 3D-CA than with QCA (p <0.001) and 0.4 +/- 1.8 mm longer than with marker guidewire measurement (p = 0.047). Marker guidewire measurements were 1.9 +/- 2.8 mm longer than QCA measurements (p <0.001). According to Bland-Altman plots, 3D-CA and marker guidewire measurements had the best agreement. In conclusion, 3-dimensional coronary modeling is highly feasible and yields more accurate assessments of the lengths of coronary segments than standard QCA.
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Van den Branden F, Van Langenhove G. Reply. J Am Coll Cardiol 2008. [DOI: 10.1016/j.jacc.2007.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Agostoni P, Vermeersch P, Vydt T, Debrauwere J, Van den Heuvel P, Convens C, Van den Branden F, Verheye S, Van Langenhove G. Acute and mid-term local vascular effects of compliant balloon inflation (GuardWire system) on saphenous vein bypass grafts: An angiographic analysis. Int J Cardiol 2007; 120:227-31. [PMID: 17175046 DOI: 10.1016/j.ijcard.2006.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 04/24/2006] [Revised: 07/19/2006] [Accepted: 09/24/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The GuardWire distal protection device reduces the incidence of periprocedural complications during percutaneous stenting of diseased saphenous vein grafts. Its mechanism of action is based on the occlusion of the vessel distal to the lesion with an inflated compliant balloon before the intervention, and the aspiration of embolized material after stent implantation. Although no safety issues related to the compliant balloon have been reported in vein graft treatment, concerns related to the potential injury of the balloon on the vessel wall have been raised. We thus evaluated the angiographic outcome of the vein graft segment where the compliant balloon of the GuardWire distal protection device was inflated during percutaneous interventions of diseased vein grafts. METHODS Forty consecutive patients undergoing vein graft stenting, all with successful delivery of the GuardWire system, were enrolled. All patients underwent 6-months follow-up angiography. Quantitative coronary angiographic analysis of the vein graft segment where the balloon was inflated was performed before and after the procedure, as well as at 6-month follow-up. RESULTS No differences in reference vessel diameter, minimal luminal diameter and diameter stenosis were evident between the three measurements. In particular, the difference between post-procedural and follow-up minimal luminal diameter (namely late loss) was 0.003+/-0.19 mm (95% confidence interval: -0.06-0.06). CONCLUSIONS This prospective study supports for the first time the "angiographic safety" of low pressure inflations of a compliant balloon in saphenous vein grafts, suggesting the absence of acute and mid-term effects on the vein graft vessel wall.
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Affiliation(s)
- Pierfrancesco Agostoni
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Lindendreef 1, 2020 Antwerp, Belgium.
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Agostoni P, Vermeersch P, Verheye S, Van den Heuvel P, Convens C, Van den Branden F, Van Langenhove G. Targeted stent use in clinical practice based on evidence from the Basel Stent Cost Effectiveness Trial (BASKET). Eur Heart J 2007; 28:1912-3; author reply 1913. [PMID: 17606468 DOI: 10.1093/eurheartj/ehm205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Agostoni P, Vermeersch P, Semeraro O, Verheye S, Van Langenhove G, Van den Heuvel P, Convens C, Van den Branden F, Bruining N. Intravascular ultrasound comparison of sirolimus-eluting stent versus bare metal stent implantation in diseased saphenous vein grafts (from the RRISC [Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent] trial). Am J Cardiol 2007; 100:52-8. [PMID: 17599440 DOI: 10.1016/j.amjcard.2007.02.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 01/25/2007] [Revised: 02/12/2007] [Accepted: 02/12/2007] [Indexed: 11/24/2022]
Abstract
The randomized Reduction of Restenosis In Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent trial compared angiographic outcomes of sirolimus-eluting stents (SESs) versus bare metal stents (BMSs) in saphenous vein grafts (SVG). Using intravascular ultrasound (IVUS) performed during 6-month follow-up angiography, we compared the vascular effects of the 2 types of stent on SVGs. Of 75 patients (96 lesions) included, 59 patients underwent IVUS in 61 SVGs; 29 patients received 40 SESs for 34 lesions, and 30 patients received 42 BMSs for 39 lesions. IVUS parameters (diameters, areas, and volumes) were compared in the 2 groups. A specific analysis was performed for overlapping SESs. Median neointimal volume was 1.3 mm(3) (interquartile range 0 to 13.1) in SESs versus 24.5 (7.8 to 39.5) in BMSs (p <0.001). Minimal incomplete stent apposition was detected at only 3 stent edges (2 BMSs, 1 SES) next to ectatic regions of the SVG. Compared with single SESs, overlapping SESs showed significant increases in neointimal reaction, with a neointimal volume of 0.6 mm(3)/mm of stent (0.1 to 1.8) versus 0 (0 to 0.4) in single SESs (p = 0.03), and this phenomenon was mainly localized in overlapping SES segments, where neointimal volume per millimeter of stent was 1.1 mm(3)/mm (0.6 to 4.4) versus 0 (0 to 1.3) in nonoverlapping segments (p = 0.05). In conclusion, SESs effectively inhibit neointimal hyperplasia volume compared with BMSs in diseased vein grafts, without evidence of increased incomplete apposition risk. The neointimal response to overlapping SES layers seems higher than to a single SES layer.
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Van den Branden F, Van Langenhove G. Increased Late Mortality After Sirolimus-Eluting Stents Versus Bare-Metal Stents in Diseased Saphenous Vein Grafts. J Am Coll Cardiol 2007; 50:261-7. [PMID: 17631219 DOI: 10.1016/j.jacc.2007.05.010] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [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: 04/02/2007] [Revised: 05/18/2007] [Accepted: 05/21/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to provide long-term follow-up data of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVG) from the RRISC (Reduction of Restenosis In Saphenous vein grafts with Cypher) trial. BACKGROUND We have previously shown that, in SVG, the use of SES reduces 6-month restenosis and repeated revascularization procedures versus the use of BMS. These data are consistent with trials in native coronary arteries. However, recently published long-term follow-up data of these trials have revealed an increased risk of adverse events (particularly very late stent thrombosis) after SES. METHODS A total of 75 patients with 96 SVG lesions were randomized to SES versus BMS. All patients underwent clinical follow-up up to 3 years. Specific outcomes assessed in this secondary post-hoc analysis were all-cause mortality, myocardial infarction, and target vessel revascularization. RESULTS Thirty-eight patients received 60 SES for 47 lesions, whereas 37 patients received 54 BMS for 49 lesions. At a median follow-up time of 32 months (interquartile range 26.5 to 36 months), 11 deaths (7 cardiac, of which 1 was caused by very late stent thrombosis and, 3 were sudden) occurred after SES (29% [95% confidence interval (CI) 17% to 45%]) versus 0 after BMS (0% [95% CI 0% to 9%]) with an absolute difference of 29% ([95% CI 14% to 45%], p < 0.001). The rates of myocardial infarction and target vessel revascularization were not different: 18% and 34% after SES, respectively, versus 5% and 38% after BMS, respectively (p = 0.15 and p = 0.74, respectively). CONCLUSIONS In this secondary post-hoc analysis, BMS were associated with lower long-term mortality than SES for SVG disease. Also, the 6-month reduction in repeated revascularization procedures with SES was lost at longer-term follow-up. (RRISC Study: Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent; http://clinicaltrials.gov/ct/show/NCT00263263?order=1; NCT00263263).
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Affiliation(s)
- Paul Vermeersch
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Bruining N, Van den Branden F, Van Langenhove G. Randomized Double-Blind Comparison of Sirolimus-Eluting Stent Versus Bare-Metal Stent Implantation in Diseased Saphenous Vein Grafts. J Am Coll Cardiol 2006; 48:2423-31. [PMID: 17174178 DOI: 10.1016/j.jacc.2006.09.021] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [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: 05/03/2006] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to compare, in a randomized fashion, sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVGs). BACKGROUND Sirolimus-eluting stents reduce restenosis and repeated revascularization in native coronary arteries compared with BMS. However, randomized data in SVG are absent. METHODS Patients with SVG lesions were randomized to SES or BMS. All were scheduled to undergo 6-month coronary angiography. The primary end point was 6-month angiographic in-stent late lumen loss. Secondary end points included binary angiographic restenosis, neointimal volume by intravascular ultrasound and major adverse clinical events (death, myocardial infarction, target lesion, and vessel revascularization). RESULTS A total of 75 patients with 96 lesions localized in 80 diseased SVGs were included: 38 patients received 60 SES for 47 lesions, whereas 37 patients received 54 BMS for 49 lesions. In-stent late loss was significantly reduced in SES (0.38 +/- 0.51 mm vs. 0.79 +/- 0.66 mm in BMS, p = 0.001). Binary in-stent and in-segment restenosis were reduced, 11.3% versus 30.6% (relative risk [RR] 0.37; 95% confidence interval [CI] 0.15 to 0.97, p = 0.024) and 13.6% versus 32.6% (RR 0.42; 95% CI 0.18 to 0.97, p = 0.031), respectively. Median neointimal volume was 1 mm(3) (interquartile range 0 to 13) in SES versus 24 (interquartile range 8 to 34) in BMS (p < 0.001). Target lesion and vessel revascularization rates were significantly reduced, 5.3% versus 21.6% (RR 0.24; 95% CI 0.05 to 1.0, p = 0.047) and 5.3% versus 27% (RR 0.19; 95% CI 0.05 to 0.83, p = 0.012), respectively. Death and myocardial infarction rates were not different. CONCLUSIONS Sirolimus-eluting stents significantly reduce late loss in SVG as opposed to BMS. This is associated with a reduction in restenosis rate and repeated target lesion and vessel revascularization procedures. (The RRISC Study; http://clinicaltrials.gov/ct/show; NCT00263263).
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Affiliation(s)
- Paul Vermeersch
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium.
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Coussement PK, Bassand JP, Convens C, Vrolix M, Boland J, Grollier G, Michels R, Vahanian A, Vanderheyden M, Rupprecht HJ, Van de Werf F. A synthetic factor-Xa inhibitor (ORG31540/SR9017A) as an adjunct to fibrinolysis in acute myocardial infarction. The PENTALYSE study. Eur Heart J 2001; 22:1716-24. [PMID: 11511121 DOI: 10.1053/euhj.2001.2777] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND ORG31540/SR90107A, a synthetic pentasaccharide, is a selective inhibitor of factor-Xa. It was hypothesized that prolonged factor-Xa inhibition with pentasaccharide may be an effective and safe antithrombotic co-therapy in acute myocardial infarction. METHODS AND RESULTS Patients (n=333) with evolving ST-segment elevation acute myocardial infarction were treated with aspirin and alteplase and randomized to unfractionated heparin, given intravenously during 48 to 72 h, or to a low, medium or high dose of pentasaccharide, administered daily for 5 to 7 days, intravenously on the first day, then subcutaneously. Coronary angiography was performed at 90 min and on days 5 to 7. Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 rates at 90 min were similar in the four treatment groups. Among patients with TIMI 3 flow at 90 min and who did not undergo a coronary intervention (n=155), a trend towards less reocclusion of the infarct-related vessel on days 5 to 7 was observed with pentasaccharide: 0.9% vs 7.0% with unfractionated heparin (P=0.065). Also, fewer revascularizations during the 30-day follow-up period were performed in patients given pentasaccharide (39% vs 51% for unfractionated heparin;P=0.054). The primary safety end-point, the combined incidence of intracranial haemorrhage and need for blood transfusion, was identical with pentasaccharide and unfractionated heparin (7.1%). One non-fatal intracranial haemorrhage occurred in the 241 patients given pentasaccharide (0.4%). CONCLUSIONS In this study, pentasaccharide given together with alteplase was safe and as effective as unfractionated heparin in restoring coronary artery patency. Prolonged administration of pentasaccharide was associated with a trend towards less reocclusion and fewer revascularizations. Selective factor-Xa-inhibition seems to be an attractive therapeutic concept in patients presenting with ST-segment elevation acute myocardial infarction.
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Van Langenhove G, Vermeersch P, Serrano P, Kutryk MJ, Stockman D, Convens C, Van den Branden F, Vanagt E, Albertal M, Van den Heuvel P. Saphenous vein graft disease treated with the Wiktor Hepamed stent: procedural outcome, in-hospital complications and six-month angiographic follow-up. Can J Cardiol 2000; 16:473-80. [PMID: 10787462] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of electively placed heparin-coated stents in the treatment of coronary saphenous vein bypass grafts with de novo lesions less than 15 mm in diameter in a prospective study with all eligible consecutive patients presenting to Middelheim Hospital, Antwerp, Belgium between September 1997 and August 1998. PATIENTS AND METHODS Fifty patients with 53 lesions were studied. Anginal class, risk factors, quantitative coronary angiographic measurements pre- and postprocedure, procedural outcome, in-hospital events, clinical status on discharge, and six-month clinical and angiographic follow-up (in 48 patients) were recorded. All patients received acetylsalicylic acid and ticlopidine, unless known intolerance was present. RESULTS On average, 1.1 stents/patient were placed in very old saphenous vein grafts (11. 7+/-3.9 years). Procedural success was 98%. Only two non-Q wave myocardial infarctions (MIs) occurred, with no Q-wave MIs and no deaths during hospital stay. Length of hospital stay was short (2. 4+/-1.7 days), and 96% of patients were free of angina on discharge. At six-months' follow-up, two patients had died, one of whom died of a noncardiac cause. One patient suffered a non-Q wave MI. At six months, 86% of patients were free from angina. Minimal luminal diameter decreased from 1.14 mm before to 3.33 mm after stenting and to 2.52 mm at six months. Restenosis was present in 22% of patients (21.6% of lesions). CONCLUSIONS In a selected population with coronary saphenous vein bypass graft disease, Wiktor heparin-coated stents can be delivered with an excellent periprocedural outcome. Six-month outcome appears favourable with a low recurrence of angina (18%) and a low rate of angiographic restenosis (21.6%).
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Paelinck B, Convens C. Transoesophageal echocardiographic diagnosis of a dissected aorticovenous anastomosis causing cardiac tamponade. Acta Cardiol 1999; 54:363. [PMID: 10672294] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Paelinck B, Vermeersch P, Stockman D, Convens C, Vaerenberg M. Usefulness of low-dose dobutamine stress echocardiography in predicting recovery of poor left ventricular function in atrial fibrillation dilated cardiomyopathy. Am J Cardiol 1999; 83:1668-71, A7. [PMID: 10392875 DOI: 10.1016/s0002-9149(99)00177-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assessment of contractile reserve was performed in 16 patients with dilated cardiomyopathy and chronic atrial fibrillation. In this prospective study, low-dose dobutamine echocardiography could predict recovery of left ventricular dysfunction and could identify tachycardiomyopathy before restoration of sinus rhythm.
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Affiliation(s)
- B Paelinck
- Department of Cardiology, General Hospital Middelheim, Antwerp, Belgium
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Abstract
Bronchopulmonary sequestrations are malformations that are often congenital; they consist of isolated nonfunctioning lung segments having no communication with functional tracheobronchial elements of the surrounding lung. They are supplied by single or multiple branches from the distal thoracic or proximal abdominal aorta, or from the celiac, splenic, intercostal, subclavian, or pulmonary artery. Due to the absence of ventilation, the lung tissue can become chronically infected. We describe an intralobar pulmonary sequestration with arterial supply from the right coronary artery.
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Van Langenhove G, Vermeersch P, Kay IP, Vaerenberg M, Heuten H, Stockman D, Convens C, Albertal M, Vrints C, Van den Branden F, Van den Heuvel P. Elective Wiktor GX stenting for symptomatic stenosis in old aortocoronary saphenous vein bypass grafts: the Antwerp experience. J Invasive Cardiol 1999; 11:274-80. [PMID: 10745530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE We compared initial outcome, peri-procedural complications and long-term clinical follow-up of elective Wiktor GX stent implantation in severely narrowed vein grafts to a historic register of elective angioplasties in saphenous vein grafts in the same center. METHODS Eighty-one consecutive patients with angina and a history of coronary artery bypass grafting (CABG), all received elective angioplasty (PTCA) of the diseased graft; we described them as group P. The next 38 consecutive patients were treated with elective angioplasty and Wiktor Stent implantation, followed by one month ticlopidine; they were called group S. CONCLUSION This retrospective study suggests that elective Wiktor stenting in old saphenous vein graft stenosis, in combination with one month ticlopidine, leads to: 1) a better angiographic result, with reduction of peri-procedural complications; and 2) a lower incidence of recurrent angina, need for invasive or surgical re-intervention, myocardial infarction and death during follow-up.
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Affiliation(s)
- G Van Langenhove
- Cardiology Department, Middelheim Hospital Antwerp, Lindendreef 1, 2020 Antwerp, Belgium
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Convens C, Vermeersch P, Paelinck B, Van den Heuvel P, Van den Branden F. Aortic coarctation: a rare and unexpected cause of secondary arterial hypertension in the elderly. Cathet Cardiovasc Diagn 1996; 39:71-4. [PMID: 8874951 DOI: 10.1002/(sici)1097-0304(199609)39:1<71::aid-ccd15>3.0.co;2-r] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a 72-year-old man with long-standing moderate hypertension, due to an aortic coarctation, who presented with a myocardial infarction. In view of his advanced age the aortic coarctation was treated conservatively.
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Affiliation(s)
- C Convens
- Department of Cardiology, General Hospital Middelhelm, Antwerpen, Belgium
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Struyf N, Moens E, Convens C, Verhelst J, Appel B, Mahler C. Tuberculous spinal epidural abscess: case report and MR imaging. Eur J Radiol 1994; 18:36-7. [PMID: 8168579 DOI: 10.1016/0720-048x(94)90363-8] [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: 01/29/2023]
Affiliation(s)
- N Struyf
- Department of Internal Medicine, AZ Middelheim, Antwerp, Belgium
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