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Donia D, Stankowski K, Figliozzi S, Pivato CA, Regazzoli D, Mangieri A, Reimers B, Bragato RM, Stefanini G, Cannata F. Bileaflet Tethering With Preserved LV Geometry and Function: An Unusual Mechanism of Functional Mitral Regurgitation. JACC Case Rep 2024; 29:102191. [PMID: 38361557 PMCID: PMC10865136 DOI: 10.1016/j.jaccas.2023.102191] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 02/17/2024]
Abstract
An 81-year-old woman presented with acute pulmonary edema. Echocardiography revealed severe functional mitral regurgitation, the mechanism of which was unusual. An atypical bileaflet tethering caused by disharmonic annular remodeling, concomitant aortic dilatation, and reduced aorto-mitral angle without left ventricular dysfunction or dilatation was found. A transcatheter edge-to-edge repair was nonetheless successfully performed.
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Affiliation(s)
- Dario Donia
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | | | | | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesco Cannata
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Inversetti A, Pivato CA, Cristodoro M, Latini AC, Condorelli G, Di Simone N, Stefanini G. Update on long-term cardiovascular risk after pre-eclampsia: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2024; 10:4-13. [PMID: 37974053 DOI: 10.1093/ehjqcco/qcad065] [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] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND/INTRODUCTION There is a need for further studies on the cardiovascular risk of women experiencing pre-eclampsia (PE). PURPOSE To update the literature regarding the association between a history of PE and subsequent cardiovascular diseases, including cardiovascular death, coronary heart diseases, heart failure, and stroke, focusing on the trend in the effect size (ES) estimates over time. METHODS AND RESULTS Following PRISMA guidelines, from inception to May 2023, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort, or case-control studies in English were included if fulfiling the following criteria:(i) The association between PE and subsequent cardiovascular disease was adjusted for clinically relevant variables, (ii) the presence of a control group, and (iii) at least 1 year of follow-up. Pooled adjusted ESs and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model. Twenty-two studies met the inclusion criteria. PE was associated with a higher risk of cardiovascular death (ES 2.08, 95% CI 1.70-2.54, I2 56%, P < 0.00001), coronary artery diseases (ES 2.04, 95% CI 1.76-2.38, I2 87%, P < 0.00001), heart failure (ES 2.47, 95% CI 1.89-3.22, I2 83%, P < 0.00001), and stroke (ES 1.75, 95% CI 1.52-2.02, I2 72%, P < 0.00001) after adjusting for potential confounders. This risk is evident in the first 1-to-3 years of follow-up and remains significant until 39 years of follow-up. CONCLUSIONS Compared to women who experienced a normal pregnancy, those suffering from PE have about double the risk of lifetime cardiovascular disease.
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Affiliation(s)
- Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Martina Cristodoro
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Alessia Chiara Latini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
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Musto C, Paolucci L, Pivato CA, Testa L, Pacchioni A, Briguori C, Esposito G, Piccolo R, Lucisano L, De Luca L, Conrotto F, Sanz-Sanchez J, Cesario V, De Felice F, Latini AC, Regazzoli D, Sardella G, Indolfi C, Reimers B, Condorelli G, Stefanini G. One-Month Dual Antiplatelet Therapy in Patients With Chronic and Acute Coronary Syndromes Treated With Bioresorbable Polymer Everolimus-Eluting Stents. Am J Cardiol 2023; 207:170-178. [PMID: 37741107 DOI: 10.1016/j.amjcard.2023.08.128] [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: 06/27/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/25/2023]
Abstract
There is a paucity of data regarding the safety of a 1-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) presenting with acute coronary syndromes (ACS). We aimed to compare the clinical outcomes of patients at HBR with chronic coronary syndrome (CCS) or ACS treated with PCI using bioresorbable polymer everolimus-eluting stent (BP-EES) followed by 1-month DAPT. Patients at HBR who underwent PCI with BP-EES were prospectively enrolled in 10 Italian centers. All patients were treated with 1-month DAPT. In case of need for anticoagulation, patients received an oral anticoagulant in addition to a P2Y12 inhibitor for 1 month, followed by oral anticoagulation only after that. The primary end point was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. Overall, 263 patients (59.4%) with CCS and 180 patients (40.6%) with ACS were enrolled. No significant difference was evident between patients with CCS and ACS for the primary end point (4.3% vs 5.6%, respectively, p = 0.497) and for each isolated component. The risk for Bleeding Academic Research Consortium (BARC) type 1 to 5 or type 3 to 5 bleedings was also similar between patients with CCS and ACS (4.3% vs 5.2%, p = 0.677, and 1.6% vs 2.9%, p = 0.351, respectively). In conclusion, among HBR patients with ACS who underwent PCI with BP-EES, a 1-month DAPT strategy is associated with a similar risk of ischemic and bleeding events compared with those with CCS.
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Affiliation(s)
- Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Paolucci
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Testa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | | | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Italy
| | | | - Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Jorge Sanz-Sanchez
- Cardiology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Vincenzo Cesario
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco De Felice
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Alessia Chiara Latini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Jones D, Spirito A, Sartori S, Smith KF, Pivato CA, Chiarito M, Cao D, Nicolas J, Beerkens F, Edens M, Pileggi B, Sen A, Zhang Z, Vogel B, Sweeny J, Baber U, Dangas G, Sharma SK, Kini A, Mehran R. PROGNOSTIC VALUE OF HIGH-SENSITIVITY C-REATIVE PROTEIN AMONG CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Cardiol 2023:S0914-5087(23)00108-9. [PMID: 37187289 DOI: 10.1016/j.jjcc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Data on the prognostic value of high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) are limited. METHODS Patients undergoing PCI at a tertiary center from January 2012 to December 2019 were included. CKD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73m2 and elevated hs-CRP was defined as >3 mg/L. Acute myocardial infarction (MI), acute heart failure, neoplastic disease, patients undergoing hemodialysis, or hs-CRP >10 mg/L were exclusion criteria. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, MI, and target vessel revascularization at 1-year after PCI. RESULTS Out of 12,410 patients, 3,029 (24.4%) had CKD. Elevated hs-CRP levels were found in 31.8% of CKD and 25.8% of non-CKD patients. At 1 year, MACE occurred in 87 (11.0%) CKD patients with elevated hs-CRP and 163 (9.5%) with low hs-CRP (adj. HR 1.26, 95% CI 0.94-1.68); among non-CKD patients, in 200 (10%) and 470 (8.1%), respectively (adj. HR 1.21, 95% CI 1.00-1.45). Hs-CRP was associated with an increased risk of all-cause death in both CKD (Adj. HR 1.92, 95% CI 1.07-3.44) and no-CKD patients (adj. HR 3.02, 95% CI 1.74-5.22). There was no interaction between hs-CRP and CKD. CONCLUSIONS Among patients undergoing PCI without acute MI, elevated hs-CRP values were not associated with a higher risk of MACE at 1 year, but with increased mortality hazards irrespective of the CKD status. The prognostic value of hs-CRP was consistent in patients with or without CKD.
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Affiliation(s)
- Davis Jones
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth F Smith
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Humanitas Research Hospital IRCCS, Rozzano-, Milan, Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frans Beerkens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madison Edens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brunna Pileggi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil
| | - Ananya Sen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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5
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Spirito A, Sharma A, Cao D, Sartori S, Zhang Z, Nicolas J, Pivato CA, Cohen R, Baber U, Sweeny J, Sharma SK, Dangas G, Kini A, Brener SJ, Mehran R. New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention. Am J Cardiol 2023; 189:22-30. [PMID: 36493579 DOI: 10.1016/j.amjcard.2022.11.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age >80 years (3 points), dialysis (6 points), left ventricular ejection fraction <30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non-ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.
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Affiliation(s)
- Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Ashutosh Sharma
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Zhongjie Zhang
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Johny Nicolas
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Rebecca Cohen
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph Sweeny
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Annapoorna Kini
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York
| | - Sorin J Brener
- Division of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine, Mount Sinai, New York, New York.
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Nardin M, Pivato CA, Cao D, Sartori S, Zhang Z, Vogel B, Nicolas J, Chiarito M, Qiu H, Chandrasekhar J, Spirito A, Abizaid A, Christiansen EH, Colombo A, de Winter RJ, Haude M, Jakobsen L, Jensen LO, Krucoff MW, Landmesser U, Saito S, Suryapranata H, De Luca G, Dangas G, Mehran R. The mega COMBO collaboration: An individual patient data pooled analysis of patients undergoing PCI with COMBO stent. Int J Cardiol 2023; 370:149-155. [PMID: 36270496 DOI: 10.1016/j.ijcard.2022.10.133] [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: 05/01/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND COMBO (OrbusNeich Medical, Hong Kong) is a dual-therapy coronary stent featuring sirolimus as antiproliferative drug and an anti-CD34+ antibody coating to attract endothelial progenitor cells favoring rapid stent re-endothelization. The Mega COMBO collaboration aimed to evaluate the performance of the COMBO stent in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI). METHODS Patient-level data of subjects undergoing PCI with the COMBO stent from the REMEDEE-Trial, REMEDEE-OCT, HARMONEE, REDUCE, SORT OUT X, REMEDEE-Registry and MASCOT studies were pooled together. The primary endpoint was 1-year target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction (TV-MI) or clinically driven target lesion revascularization (CD-TLR). Secondary outcomes were the individual components of the primary endpoint and stent thrombosis (ST). Endpoints were evaluated against performance goals based on the EAPCI (the European Association of Percutaneous Coronary Intervention) recommendations for new drug-eluting stents. RESULTS A total of 6753 patients (mean age 63.7 ± 11.4 years, 23% women) were included. At 1-year follow-up, TLF occurred in 303 (4.6%) patients. The rates of cardiovascular death, TV-MI, and CD-TLR were 1.3%, 1.8%, and 2.5%, respectively. The rate of definite/probable ST was 0.73%, early ST (<1 month) was 0.48%, while late ST (1-12 months) was 0.26%. The performance goals were met for all of the evaluated endpoints. CONCLUSIONS This large patient-level pooled analysis provides a comprehensive outline of the performance of the dual-therapy COMBO stent. The low rates of primary and secondary endpoints suggest that this stent technology may be a good alternative to other contemporary drug eluting coronary stent platforms.
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Affiliation(s)
- Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Third Medicine Division, ASST Spedali Civili, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Hanbo Qiu
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Robbert J de Winter
- Department Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto, Kamakura, Japan
| | | | - Giuseppe De Luca
- Department of Medical and Surgical Sciences, University of Sassari, Sassari, Italy
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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7
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Nicolas J, Dangas G, Chiarito M, Pivato CA, Spirit A, Cao D, Giustino G, Beerkens F, Camaj A, Vogel B, Sartori S, Yamamoto K, Kimura T, Kim BK, Baber U, Mehran R. Efficacy and Safety of P2Y12 Inhibitor Monotherapy After Complex PCI: A Collaborative Systematic Review and Meta-Analysis. Eur Heart J Cardiovasc Pharmacother 2022; 9:240-250. [PMID: 36564015 DOI: 10.1093/ehjcvp/pvac071] [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] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
AIMS Complex percutaneous coronary intervention (C-PCI) is associated with an increased risk of ischemic and bleeding complications. We aimed to assess the safety and efficacy of a 1-3-month dual antiplatelet therapy (DAPT) regimen followed by P2Y12 inhibitor monotherapy after C-PCI. METHODS AND RESULTS We conducted a meta-analysis of randomized trials comparing a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy with standard (≥12 months) DAPT in patients undergoing C-PCI. C-PCI criteria and the co-primary bleeding and ischemic outcomes were determined according to each trial. Secondary outcomes included major bleeding, all-cause death, myocardial infarction, and stent thrombosis. All outcomes were evaluated at 12 months after randomization. We used hazard ratios (HRs) and 95% confidence interval (CI) as a metric of choice for treatment effects with random-effects models. Among 8299 screened studies, five randomized trials fulfilled the eligibility criteria. In the pooled population of 34 615 patients, 8818 (25.5%) underwent C-PCI. As compared with standard DAPT, a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy reduced the bleeding risk in C-PCI (HR:0.66, 95% CI:0.44-0.98) and non-C-PCI (HR:0.60, 95% CI:0.45-0.79) patients (p-interaction = 0.735). Furthermore, the risk for the primary ischemic endpoint was similar in patients randomized to either arm, with significant effect modification by PCI complexity showing an enhanced benefit of 1-3-month DAPT in patients undergoing C-PCI (C-PCI, HR:0.69, 95% CI:0.48-1.00; non-C-PCI, HR:1.04, 95% CI:0.84-1.30; p-interaction = 0.028). CONCLUSION As compared with a standard DAPT, a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy reduced bleeding complications after C-PCI without increasing the risk of ischemic events.
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Affiliation(s)
- Johny Nicolas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Mauro Chiarito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Carlo Andrea Pivato
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Alessandro Spirit
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA.,Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Gennaro Giustino
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Frans Beerkens
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Anton Camaj
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Usman Baber
- University of Oklahoma Health Sciences Center, OK City, OK, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
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8
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Chiarito M, Cao D, Sartori S, Zhang Z, Vogel B, Nicholas J, Pivato CA, Spirito A, Tavenier A, Effron M, Stefanini GG, Baber U, Kapadia S, Rao S, Henry TD, Pocock S, Dangas G, Kini A, Mehran R. 761 PRASUGREL OR CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES AT DIFFERENT THROMBOTIC RISK: RESULTS FROM THE PROMETHEUS STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.154] [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: 12/23/2022]
Abstract
Abstract
Background
Potent P2Y12 inhibitors are recommended in patients with acute coronary syndrome (ACS), although the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile. We evaluated if the benefits associated with prasugrel vs. clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI) are similar in patients with different thrombotic risk profiles.
Methods
PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. Patients were defined at high thrombotic risk if presenting with a clinical and a procedural risk feature. The primary endpoint was major adverse cardiac events (MACE), composite of death, myocardial infarction, stroke, or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis and with multivariable Cox regression.
Results
Among 16,065 patients, 4,293 were defined at high and 11,772 at low-to-moderate thrombotic risk. Patients receiving prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. High thrombotic risk patients had increased rates of ischemic and bleeding events at 90-day and 1-year follow-up. Patients treated with prasugrel had a lower adjusted 1-year risk of MACE (HR 0.86, 95% CI 0.77-0.96), irrespective of their thrombotic risk (pinteraction =0.32). Stratifying the study population by number of risk factors there was a significant interaction (pinteraction =0.026) for a greater reduction in MACE with prasugrel among patients with ≤1 thrombotic risk factor. The risk of clinically significant bleeding was similar in patients treated with prasugrel and clopidogrel.
Conclusions
Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events at 1 year. Prasugrel, mainly reserved to patients with less comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel.
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Affiliation(s)
| | | | - Samantha Sartori
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Zhongjie Zhang
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Birgit Vogel
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Johny Nicholas
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | | | - Alessandro Spirito
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Annerieke Tavenier
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | | | | | - Usman Baber
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Samir Kapadia
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | | | | | | | - George Dangas
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Annapoorna Kini
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
| | - Roxana Mehran
- The Zena And Michael A.Wiener Cardiovascular Institute, Icahn School Of Medicine At Mount Sinai , New York
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9
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Nicolas J, Pivato CA, Chiarito M, Beerkens F, Cao D, Mehran R. Evolution of drug-eluting coronary stents: a back-and-forth journey from the bench-to-bedside. Cardiovasc Res 2022; 119:631-646. [PMID: 35788828 DOI: 10.1093/cvr/cvac105] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents effectively prevented abrupt vessel closure but were limited by in-stent restenosis due to smooth muscle cell proliferation and neointimal hyperplasia. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over bare-metal stents as it mitigated the risk of in-stent restenosis. Nonetheless, they had several design limitations that increased the risk of late stent thrombosis. Significant advances in stent design, including thinner struts, enhanced polymers' formulation, and more potent antiproliferative agents, have led to the introduction of new-generation DES with a superior safety profile. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. We conclude by discussing the clinical implications of stent design in high-risk subsets of patients.
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Affiliation(s)
- Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Frans Beerkens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Sisinni A, Munafò A, Pivato CA, Adamo M, Taramasso M, Scotti A, Parlati AL, Italia L, Voci D, Buzzatti N, Denti P, Ancona F, Marengo A, Sala A, Bodega F, Ruffo MM, Curello S, Castiglioni A, Montorfano M, de Bonis M, Alfieri O, Agricola E, Colombo A, Maisano F, Metra M, Margonato A, Godino C. Effect of Chronic Kidney Disease on 5-Year Outcome in Patients With Heart Failure and Secondary Mitral Regurgitation Undergoing Percutaneous MitraClip Insertion. Am J Cardiol 2022; 171:105-114. [PMID: 35317926 DOI: 10.1016/j.amjcard.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/01/2022]
Abstract
Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60 ml/min/1.73 m2) (n = 196), mild-to-moderate CKD (30 to 59 ml/min/1.73 m2) (n = 267), and severe CKD (<30 ml/min/1.73 m2) (n = 102). The primary end point was a composite of overall death and the first rehospitalization for HF, the secondary end points were overall death, cardiac death, and first rehospitalization for HF. CKD was present in about 2/3 of patients. At 5-year Kaplan-Meier analysis, primary clinical end point occurred in 60% of patients with normal eGFR, compared with 73% cases in patients with mild-to-moderate CKD and 91% in patients with severe CKD (p <0.001). Long-term overall death rate significantly decreased with increasing eGFR, and cardiac death and rehospitalization for HF rates. Multivariate Cox regression analysis identified severe CKD as the strongest independent predictor of adverse outcome (hazard ratio 2.136, 95% confidence interval 1.164 to 3.918, p = 0.014). In conclusion, CKD affected about 2/3 of patients who underwent MitraClip treatment for severe SMR, and it was a strong and independent predictor of 5-year adverse outcomes.
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11
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Feldman D, Cao D, Nicolas J, Hengstenberg C, Zhang Z, Sartori S, Beerkens F, Pivato CA, Chiarito M, Satish M, Jones DB, Iyer D, Power D, Chen H, Camaj A, Razuk V, Roumeliotis A, Jeger RV, Violini R, Ferrari M, Mehran R, Dangas GD. IMPACT OF CORONARY ARTERY DISEASE ON CLINICAL OUTCOMES AFTER TAVR: INSIGHTS FROM THE BRAVO-3 RANDOMIZED TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01717-x] [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: 11/29/2022]
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12
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Koshy AN, Cao D, Sartori S, Kini AS, Zhang Z, Claessen B, Nardin M, Pivato CA, Chandiramani R, Giustino G, Chiarito M, Nicolas J, Sharma SK, Mehran R. PREDICTORS OF ANTIPLATELET CESSATION IN A REAL-WORLD PATIENT POPULATION WITH CORONARY STENTS UNDERGOING NONCARDIAC SURGERY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01893-9] [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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13
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Sanz-Sánchez J, Andrea Pivato C, Pasquale Leone P, Regazzoli D, Chiarito M, Petriello G, Reimers B, Condorelli y G, G. Stefanini G. Correcci�n en el art�culo de Sanz-S�nchez et al., �Tratamiento antiagregante plaquetario �nico o doble tras implante percut�neo de v�lvula a�rtica. Metan�lisis de ensayos cl�nicos aleatorizados�, REC Interv Cardiol. 2021;3:175-181. RECIC 2022. [DOI: 10.24875/recic.m21000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, Nicolas J, Pivato CA, Nardin M, Krishnan P, Kini A, Sharma S, Pocock S, Dangas G. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet 2021; 398:1974-1983. [PMID: 34793743 DOI: 10.1016/s0140-6736(21)02326-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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] [Received: 09/25/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contrast-associated acute kidney injury can occur after percutaneous coronary intervention (PCI). Prediction of the contrast-associated acute kidney injury risk is important for a tailored prevention and mitigation strategy. We sought to develop a simple risk score to estimate contrast-associated acute kidney injury risk based on a large contemporary PCI cohort. METHODS Consecutive patients undergoing PCI at a large tertiary care centre between Jan 1, 2012, and Dec 31, 2020, with available creatinine measurements both before and within 48 h after the procedure, were included; only patients on chronic dialysis were excluded. Patients treated between 2012 and 2017 comprised the derivation cohort and those treated between 2018 and 2020 formed the validation cohort. The primary endpoint was contrast-associated acute kidney injury, defined according to the Acute Kidney Injury Network. Independent predictors of contrast-associated acute kidney injury were derived from multivariate logistic regression analysis. Model 1 included only pre-procedural variables, whereas Model 2 also included procedural variables. A weighted integer score based on the effect estimate of each independent variable was used to calculate the final risk score for each patient. The impact of contrast-associated acute kidney injury on 1-year deaths was also evaluated. FINDINGS 32 378 PCI procedures were performed and screened for inclusion in the present analysis. After the exclusion of patients without paired creatinine measurements, patients on chronic dialysis, and multiple procedures, 14 616 patients were included in the derivation cohort (mean age 66·2 years, 29·2% female) and 5606 were included in the validation cohort (mean age 67·0 years, 26·4% female). Contrast-associated acute kidney injury occurred in 860 (4·3%) patients. Independent predictors of contrast-associated acute kidney injury included in Model 1 were: clinical presentation, estimated glomerular filtration rate, left ventricular ejection fraction, diabetes, haemoglobin, basal glucose, congestive heart failure, and age. Additional independent predictors in Model 2 were: contrast volume, peri-procedural bleeding, no flow or slow flow post procedure, and complex PCI anatomy. The occurrence of contrast-associated acute kidney injury in the derivation cohort increased gradually from the lowest to the highest of the four risk score groups in both models (2·3% to 34·9% in Model 1, and 2·0% to 38·8% in Model 2). Inclusion of procedural variables in the model only slightly improved the discrimination of the risk score (C-statistic in the derivation cohort: 0·72 for Model 1 and 0·74 for model 2; in the validation cohort: 0·84 for Model 1 and 0·86 for Model 2). The risk of 1-year deaths significantly increased in patients with contrast-associated acute kidney injury (10·2% vs 2·5%; adjusted hazard ratio 1·76, 95% CI 1·31-2·36; p=0·0002), which was mainly due to excess 30-day deaths. INTERPRETATION A contemporary simple risk score based on readily available variables from patients undergoing PCI can accurately discriminate the risk of contrast-associated acute kidney injury, the occurrence of which is strongly associated with subsequent death. FUNDING None.
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Affiliation(s)
- Roxana Mehran
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mauro Chiarito
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samantha Sartori
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johny Nicolas
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Matteo Nardin
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Prakash Krishnan
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- London School of Hygiene & Tropical Medicine, London, UK
| | - George Dangas
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Beerkens FJ, Singh R, Cao D, Claessen BE, Nicolas J, Sartori S, Snyder C, Camaj A, Giustino G, Power D, Razuk V, Jones D, Tavenier AH, Pivato CA, Nardin M, Chiarito M, Krishnan P, Barman N, Baber U, Sweeny J, Dangas G, Sharma SK, Mehran R, Kini A. Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft. Catheter Cardiovasc Interv 2021; 98:E785-E795. [PMID: 34478235 DOI: 10.1002/ccd.29935] [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: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. BACKGROUND Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. METHODS We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI. RESULTS Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow- and no-reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56-8.95; p < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. CONCLUSIONS Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.
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Affiliation(s)
- Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ranbir Singh
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bimmer E Claessen
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johny Nicolas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clayton Snyder
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anton Camaj
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Victor Razuk
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davis Jones
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne H Tavenier
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Isala, Zwolle, The Netherlands
| | - Carlo Andrea Pivato
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matteo Nardin
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph Sweeny
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sanz-Sánchez J, Andrea Pivato C, Pasquale Leone P, Regazzoli D, Chiarito M, Petriello G, Reimers B, Condorelli y G, G. Stefanini G. Tratamiento antiagregante plaquetario �nico o doble tras implante percut�neo de v�lvula a�rtica. Metan�lisis de ensayos cl�nicos aleatorizados. RECIC 2021. [DOI: 10.24875/recic.m21000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Angiolillo D, Pivato CA, Cao D, Kunadian V, Sartori S, Zhang Z, Cohen D, Collier T, Dudek D, Gil R, Huber K, Kornowski R, Mehta S, Ohman EM, Oldroyd K, Sardella G, Sharma S, Shlofmitz R, Weisz G, Witzenbichler B, Dangas G, Pocock S, Mehran R. TCT-217 Predictors of Dyspnea in Patients Receiving Ticagrelor After PCI: Insights From the Twilight Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1070] [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: 11/17/2022]
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Beerkens F, Cao D, Dangas G, Sartori S, Zhang Z, Nicolas J, Camaj A, Claessen B, Pivato CA, Power D, Razuk V, Jones D, Angiolillo D, Mehta S, Gibson CM, Sardella G, Sharma S, Shlofmitz R, Collier T, Pocock S, Mehran R. TCT-38 Ticagrelor With and Without Aspirin in Patients With Previous Coronary Artery Bypass Graft Undergoing Percutaneous Coronary Intervention: The TWILIGHT-CABG Subanalysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nardin M, Pivato CA, Cao D, Zhang Z, Sartori S, Nicolas J, Chiarito M, Qiu H, Abizaid A, Christiansen E, Colombo A, de Winter R, Haude M, Jakobsen L, Jensen LO, Landmesser U, Saito S, Suryapranata H, De Luca G, Dangas G, Mehran R. TCT-346 The Mega COMBO Collaboration: An Individual Patient Data Pooled Analysis of Patients Undergoing PCI With COMBO Stent. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chiarito M, Pivato CA, Cao D, Zhang Z, Sartori S, Nicolas J, Nardin M, Kapadia S, Weiss S, Rao S, Henry T, Effron M, Weintraub W, Pocock S, Dangas G, Kini A, Mehran R. TCT-228 Prasugrel or Clopidogrel in Patients With Acute Coronary Syndromes With Multivessel Disease: Results From the PROMETHEUS Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pivato CA, Cao D, Kunadian V, Sartori S, Zhang Z, Dangas G, Angiolillo D, Briguori C, Cohen D, Gibson CM, Moliterno D, Sharma S, Escaned J, Pocock S, Mehran R. TCT-39 Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index: TWILIGHT-BMI Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.889] [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: 10/19/2022]
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Chiarito M, Cao D, Zhongjie Z, Sartori S, Nicolas J, Nardin M, Pivato CA, Tavenier A, Rao SV, Henry TD, Pocock S, Dangas G, Baber U, Kini A, Mehran R. Prasugrel or clopidogrel in patients with acute coronary syndromes at high thrombotic risk: results from the PROMETHEUS study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1423] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Potent P2Y12 inhibitors are recommended on top of aspirin in patients presenting with acute coronary syndrome (ACS). However, guideline recommendations suggest that the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile.
Purpose
It is poorly investigated if the benefits derived from potent P2Y12 inhibition in patients with ACS depend on the individual thrombotic risk profile. Our aim was to evaluate if the benefits associated with prasugrel vs. clopidogrel in patients with ACS undergoing percutaneous coronary intervention (PCI) are similar in case of different thrombotic risk profiles.
Methods
PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. According to the 2020 ESC guidelines for non-ST elevation-ACS, patients are defined at high thrombotic risk if presenting with a clinical (diabetes mellitus requiring medication, history of recurrent myocardial infarction [MI], multivessel coronary artery disease [CAD], polyvascular [coronary and peripheral] disease, premature (<45 years) CAD, and chronic kidney disease [estimated glomerular filtration rate <60 ml/min/1.73m2]) and procedural (≥3 stents implanted, ≥3 lesions treated, total stent length >60 mm, complex revascularization [left main PCI, bifurcation or chronic total occlusion]) risk features. The primary endpoint was major adverse cardiac events (MACE), a composite of death, MI, stroke or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis to assess the effect of prasugrel vs. clopidogrel and with multivariable Cox regression to evaluate the impact of thrombotic risk.
Results
Among 16065 patients, 4293 were defined at high thrombotic risk and 11772 at low-to-moderate thrombotic risk. Patients treated with prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. Patients at high thrombotic risk had higher rates of both ischemic and bleeding events at 90 days and at 1 year. Patients treated with prasugrel had a lower adjusted risk of MACE at 1 year (HR 0.86, 95% CI 0.77–0.96), with no significant interaction between effect estimates and thrombotic risk. However, after stratifying the study population by the number of risk factors, there was a significant interaction for a greater reduction in MACE with prasugrel in patients with ≤1 thrombotic risk factor. Conversely, there were no differences in major bleeding among patients treated with prasugrel and clopidogrel.
Conclusions
Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events. Prasugrel, although mainly reserved to patients with lower burden of comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo and Eli Lilly and Company Clinical outcomes at 1 year.Impact of number of risk factors
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Affiliation(s)
- M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Z Zhongjie
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C A Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S V Rao
- Duke University Medical Center, Durham, United States of America
| | - T D Henry
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Tavenier AH, Chiarito M, Cao D, Pivato CA, Nicolas J, Nardin M, Sartori S, Baber U, Angiolillo DJ, Capodanno D, Kini AS, Sharma SK, Dangas G, Mehran R. Guided and unguided de-escalation from potent P2Y12 inhibitors among patients with ACS: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy (DAPT) with a potent P2Y12 inhibitor is recommended in patients with acute coronary syndrome (ACS) and should be tailored according to ischemic and bleeding risks, which are highest in the acute phase, and gradually attenuate overtime. De-escalation strategies of DAPT aim to optimize this balance of risks.
Purpose
We compared guided or unguided DAPT de-escalation strategies from potent P2Y12 inhibitors to either clopidogrel or lower doses of potent P2Y12 inhibitors versus standard DAPT with potent P2Y12 inhibitors among patients with ACS.
Methods
PubMed, Google Scholar and Cochrane Central Register of Controlled Trials were searched from inception till March 10th 2021. 1633 records were screened on DAPT de-escalation strategies after ACS for inclusion. Aspirin monotherapy and non-randomized trials were excluded.
The primary endpoint was BARC ≥2 bleeding. Other endpoints included MACE (defined according to the definitions reported in the original study protocols), all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, and stroke. Hazard ratios (HRs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. Heterogeneity was assessed with the I2 index. We assessed the interaction between de-escalation strategy (guided vs. unguided) and treatment with a random-effects meta-regression analysis with the empirical Bayes method. This study has been submitted to PROSPERO for registration.
Preliminary findings
Four randomised trials and a total of 8,082 patients randomly allocated to a de-escalation strategy (genetic guided to clopidogrel, n=1,242; platelet function guided to clopidogrel, n=1,304; unguided to clopidogrel (n=323); unguided to lower dose, n=1,170) or standard DAPT (n=4,043) were included in our analysis. De-escalation strategy had a reduction in BARC ≥2 bleeding (HR 0.57, 95% CI 0.37–0.89; I2=81%). MACE (HR 0.79, 95% CI 0.62–1.02; I2=0%), all-cause death (HR 0.89, 95% CI 0.58–1.36), cardiovascular death (HR 0.63, 95% CI 0.36–1.10; I2=0%), myocardial infarction (HR 0.81, 95% CI 0.56–1.17; I2=0%), stent thrombosis (HR 0.57, 95% CI 0.19–1.74; I2=0%) and stroke (HR 0.73, 95% CI 0.39–1.35; I2=0%) did not differ between patients with a de-escalation strategy and those without. Meta-regression analysis did not show any significant interaction between de-escalation method (guided vs. unguided) and treatment effects, except for BARC ≥2 bleeding (P interaction = 0.070), suggesting a greater reduction with unguided de-escalation.
Conclusion
A de-escalation strategy of DAPT after ACS was associated with a lower number of clinically relevant bleeding events, mostly in patients who underwent unguided de-escalation, while no association with increased ischemic events was found. However, the observed broad confidence intervals limit the certainty of our findings.
Funding Acknowledgement
Type of funding sources: None. BARC ≥2 bleedingMACE
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Affiliation(s)
- A H Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C A Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | | | - A S Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S K Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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24
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Kini A, Cao D, Nardin M, Sartori S, Zhang Z, Pivato CA, Chiarito M, Nicolas J, Vengrenyuk Y, Krishnamoorthy P, Sharma SK, Dangas G, Fuster V, Mehran R. Types of myocardial injury and mid-term outcomes in patients with COVID-19. Eur Heart J Qual Care Clin Outcomes 2021; 7:438-446. [PMID: 34458912 DOI: 10.1093/ehjqcco/qcab053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the acute and chronic patterns of myocardial injury among patients with coronavirus disease-2019 (COVID-19), and their mid-term outcomes. METHODS AND RESULTS Patients with laboratory-confirmed COVID-19 who had a hospital encounter within the Mount Sinai Health System (New York City) between 27 February 2020 and 15 October 2020 were evaluated for inclusion. Troponin levels assessed between 72 h before and 48 h after the COVID-19 diagnosis were used to stratify the study population by the presence of acute and chronic myocardial injury, as defined by the Fourth Universal Definition of Myocardial Infarction. Among 4695 patients, those with chronic myocardial injury (n = 319, 6.8%) had more comorbidities, including chronic kidney disease and heart failure, while acute myocardial injury (n = 1168, 24.9%) was more associated with increased levels of inflammatory markers. Both types of myocardial injury were strongly associated with impaired survival at 6 months [chronic: hazard ratio (HR) 4.17, 95% confidence interval (CI) 3.44-5.06; acute: HR 4.72, 95% CI 4.14-5.36], even after excluding events occurring in the first 30 days (chronic: HR 3.97, 95% CI 2.15-7.33; acute: HR 4.13, 95% CI 2.75-6.21). The mortality risk was not significantly different in patients with acute as compared with chronic myocardial injury (HR 1.13, 95% CI 0.94-1.36), except for a worse prognostic impact of acute myocardial injury in patients <65 years of age (P-interaction = 0.043) and in those without coronary artery disease (P-interaction = 0.041). CONCLUSION Chronic and acute myocardial injury represent two distinctive patterns of cardiac involvement among COVID-19 patients. While both types of myocardial injury are associated with impaired survival at 6 months, mortality rates peak in the early phase of the infection but remain elevated even beyond 30 days during the convalescent phase.
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Affiliation(s)
- Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.,Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.,Division of Medicine, ASST Spedali Civili, Brescia, Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Yuliya Vengrenyuk
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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Pivato CA, Vogel B, Mehran R. Sex disparities continue to characterise the management of non-ST-elevation acute coronary syndrome. Med J Aust 2021; 216:135-136. [PMID: 34499361 DOI: 10.5694/mja2.51253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Andrea Pivato
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.,The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America.,Humanitas University, Milan, Italy
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.,The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.,The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America
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26
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Stefanini GG, Cerrato E, Pivato CA, Joner M, Testa L, Rheude T, Pilgrim T, Pavani M, Brouwer J, Lopez Otero D, Munoz Garcia E, Barbanti M, Biasco L, Varbella F, Reimers B, Jimenez Diaz VA, Leoncini M, Salido Tahoces ML, Ielasi A, de la Torre Hernandez JM, Mylotte D, Garot P, Chieffo A, Nombela-Franco L. Unplanned Percutaneous Coronary Revascularization After TAVR: A Multicenter International Registry. JACC Cardiovasc Interv 2021; 14:198-207. [PMID: 33478637 DOI: 10.1016/j.jcin.2020.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/23/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). BACKGROUND Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. METHODS Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. RESULTS Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). CONCLUSIONS Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
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Affiliation(s)
- Giulio G Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | | | - Luca Testa
- IRCSS Policlinico San Donato, Milan, Italy
| | | | | | | | - Jorn Brouwer
- St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Marco Barbanti
- AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Luigi Biasco
- Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy
| | | | - Massimo Leoncini
- SSD Cardiologia Interventistica Ospedale di Sanremo, Sanremo, Italy
| | | | - Alfonso Ielasi
- Sant'Ambrogio Clinical Institute, Milan, Italy; Seriate Hospital, Bergamo, Italy
| | | | | | - Philippe Garot
- Hopital Privé Jacques Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-Santé, Massy, France
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D'Ascenzo F, De Filippo O, Borin A, Barbieri L, Adamo M, Morici N, Truffa Giachet A, Iannaccone M, Crimi G, Gaido L, Bocchino PP, Pivato CA, Campo G, Trabattoni D, Chieffo A, Gaibazzi N, Angelini F, Rubboli A, Rognoni A, Musumeci G, Ugo F, Gili S, Cortese B, Vadalà P, Dusi V, Gallone G, Patti G, de Ferrari GM. Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry. Int J Cardiol 2021; 332:227-234. [PMID: 33794235 PMCID: PMC8006512 DOI: 10.1016/j.ijcard.2021.03.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Torino, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milano, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Rubboli
- Division of Cardiology, S Maria delle Croci Hospital, Ravenna, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Fabrizio Ugo
- Division of Cardiology, Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
| | - Sebastiano Gili
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Bernardo Cortese
- San Carlo Clinic, Milan, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Paolo Vadalà
- Division of Cardiology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Godino C, Sisinni A, Pivato CA, Adamo M, Taramasso M, Parlati A, Italia L, Voci D, Scotti A, Munafò A, Buzzatti N, Denti P, Ancona F, Fiore G, Sala A, Vergara P, Bodega F, Ruffo MM, Curello S, Castiglioni A, De Bonis M, Alfieri O, Agricola E, Maisano F, Metra M, Colombo A, Margonato A. Prognostic Value of Pre-operative Atrial Fibrillation in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation. Am J Cardiol 2021; 143:51-59. [PMID: 33359201 DOI: 10.1016/j.amjcard.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
Limited data are available regarding the independent prognostic role of preoperative atrial fibrillation (AF) after transcatheter mitral valve repair with MitraClip. We sought to evaluate the impact of preoperative AF in patients with heart failure (HF) and concomitant secondary mitral regurgitation (MR) after MitraClip treatment. The study included 605 patients with significant secondary MR from a multicenter international registry. Patients were stratified into 2 groups according to the presence or absence of preoperative AF. Primary end point was 5-year overall death, secondary end points were 5-year cardiac death and first re-hospitalization for HF. To account for baseline differences, patients were propensity score matched 1:1. The overall prevalence of preoperative AF was 44%. At 5-year Kaplan-Meier analysis, compared with patients without AF, those with AF had significantly more adverse events in term of overall death (67% vs 43%; HR 1.84, log-rank p <0.001) and cardiac death (56% vs 29%; HR 2.11, log-rank p <0.001) and re-hospitalization for HF (63% vs 52%; HR 1.33, log-rank p = 0.048). Multivariate analysis identified AF as independent predictor of worse outcome in term of primary end point (HR 1.729, 95% C.I. 1.060 to 2.821; p = 0.028). After propensity score matching, patients with AF had higher rates of death and cardiac mortality but similar rates of re-hospitalization for HF. In conclusion, in patients with HF undergoing MitraClip treatment for secondary MR, preoperative AF is common and an unfavourable predictor of 5-year death and cardiac death. However, AF did not affect the frequency of re-hospitalization for HF.
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Affiliation(s)
- Cosmo Godino
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy..
| | - Antonio Sisinni
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Antonio Parlati
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Italia
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Davide Voci
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Andrea Munafò
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Sala
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Francesca Bodega
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Salvatore Curello
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Colombo
- Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Margonato
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
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Pivato CA, Regazzoli D, Rossi A, Pagliaro B. Percutaneous Treatment of Paravalvular Leak in Rapid-Deployment Bioprosthetic Aortic Valve With Balloon Dilation. Cardiovascular Revascularization Medicine 2020; 21:47-49. [DOI: 10.1016/j.carrev.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
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Pivato CA, Ferrante G, Briani M, Sanz Sanchez J, Reimers B, Pagnotta P. MitraClip Treatment for Severe Mitral Regurgitation Due to Chordae Rupture Following Impella CP Support in a Patient With Severe Aortic Stenosis. Cardiovasc Revasc Med 2020; 28S:118-120. [PMID: 32855084 DOI: 10.1016/j.carrev.2020.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
We report the case of an 85-year-old man with severe aortic stenosis who underwent high-risk percutaneous coronary intervention with Impella CP support. Unfortunately, the device caused mitral chordae tendineae rupture leading to severe mitral regurgitation. The patient underwent a staged fully percutaneous treatment with transcatheter aortic valve replacement followed by elective Mitraclip therapy. Echocardiographic monitoring is of paramount importance during Impella insertion and removal in order to avoid and deal with mitral damage. Mitraclip therapy is a feasible rescue therapy for severe mitral regurgitation due to chordae rupture in patients at high risk for surgery.
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Affiliation(s)
- Carlo Andrea Pivato
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Giuseppe Ferrante
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Martina Briani
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Jorge Sanz Sanchez
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Paolo Pagnotta
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
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Godino C, Pivato CA, Rubino C, Russi A, Cera M, Margonato A. Antithrombotic Therapy After Percutaneous Coronary Intervention in Atrial Fibrillation. Am J Cardiol 2020; 129:122-124. [PMID: 32540165 DOI: 10.1016/j.amjcard.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Cosmo Godino
- San Raffaele Scientific Institute, Milan, Italy.
| | | | | | - Anita Russi
- San Raffaele Scientific Institute, Milan, Italy
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Affiliation(s)
| | - Alberto Margonato
- Department of Cardio-Thoracic-Vascular, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cosmo Godino
- Department of Cardio-Thoracic-Vascular, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Godino C, Melillo F, Bellini B, Mazzucca M, Pivato CA, Rubino F, Figini F, Mazzone P, Della Bella P, Margonato A, Colombo A, Montorfano M. Percutaneous left atrial appendage closure versus non-vitamin K oral anticoagulants in patients with non-valvular atrial fibrillation and high bleeding risk. EUROINTERVENTION 2020; 15:1548-1554. [DOI: 10.4244/eij-d-19-00507] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Godino C, Giannattasio A, Scotti A, Baldetti L, Pivato CA, Munafò A, Cappelletti A, Beneduce A, Melillo F, Chiarito M, Biondi Zoccai G, Frati G, Fragasso G, Azzalini L, Carlino M, Montorfano M, Margonato A, Colombo A. Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion. Heart 2019; 105:1096-1102. [PMID: 30792237 DOI: 10.1136/heartjnl-2018-314076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/30/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThe aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI).MethodsFrom a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs.ResultsUp to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients.ConclusionsAt long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Giannattasio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Chiarito
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Milan, Italy
| | - Giuseppe Biondi Zoccai
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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Chiarito M, Sardella G, Colombo A, Briguori C, Testa L, Bedogni F, Fabbiocchi F, Paggi A, Palloshi A, Tamburino C, Margonato A, Pivato CA, Baber U, Calcagno S, Giordano A, Godino C, Stefanini GG. Safety and Efficacy of Polymer-Free Drug-Eluting Stents. Circ Cardiovasc Interv 2019; 12:e007311. [DOI: 10.1161/circinterventions.118.007311] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/21/2022]
Affiliation(s)
- Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | | | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | | | - Anita Paggi
- Department of Interventional Cardiology, Sant’Anna Hospital Como (A. Paggi.)
| | - Altin Palloshi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico Città Studi, Milan, Italy (A. Palloshi)
| | - Corrado Tamburino
- U.O.C. Cardiologia, C.A.S.T. Centro Alte Specialità e Trapianti, P.O. G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Italy (C.T.)
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Usman Baber
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B.)
| | - Simone Calcagno
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | - Cosmo Godino
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Giulio G. Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
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Moscarella E, Ielasi A, Godino C, Ferrante G, Pivato CA, Chiarito M, Cappelletti A, Perfetti G, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, rosario parisi, Locuratolo N, Anzuini A, Margonato A, Benassi A, Calabro' P, Briguori C, Fabbiocchi F, Reimers B, Bartorelli A, Colombo A. TCT-469 One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in patients with acute coronary syndrome. Insight from the ULISSE registry. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1641] [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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Godino C, Beneduce A, Ferrante G, Ielasi A, Pivato CA, Chiarito M, Cappelletti A, Perfetti G, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, Parisi R, Rutigliano D, Locuratolo N, Anzuini A, Tespilli M, Margonato A, Benassi A, Briguori C, Fabbiocchi F, Reimers B, Bartorelli A, Colombo A. One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in all-comers population. Insight from the ULISSE registry (ULtimaster Italian multicenter all comerS Stent rEgistry). Int J Cardiol 2018; 260:36-41. [DOI: 10.1016/j.ijcard.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/02/2018] [Indexed: 10/17/2022]
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Godino C, Pivato CA, Chiarito M, Donahue M, Testa L, Colantonio R, Cappelletti A, Milazzo D, Parisi R, Nicolino A, Moshiri S, Aprigliano G, Palloshi A, Zavalloni Parenti D, Rutigliano D, Locuratolo N, Melillo F, Scotti A, Arrigoni L, Montorfano M, Fattori R, Presbitero P, Sardella G, Bedogni F, Margonato A, Briguori C, Colombo A. Polymer-free amphilimus-eluting stent versus biodegradable polymer biolimus-eluting stent in patients with and without diabetes mellitus. Int J Cardiol 2017; 245:69-76. [DOI: 10.1016/j.ijcard.2017.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
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Godino C, Pivato CA, Beneduce A, Cappelletti A, Ferrante G, Fabbiocchi F, Falcone S, Ielasi A, Pierri A, Chiarito M, Magni V, Perfetti G, Scotti A, Montorfano M, De Martini S, Parisi R, Rutigliano D, Locuratolo N, Margonato A, Benassi A, Anzuini A, Reimers B, Tespilli M, Briguori C, Bartorelli A, Colombo A. TCT-249 Clinical Outcomes of Biodegradable Polymer Sirolimus Eluting Stent in Diabetes Mellitus Patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.322] [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: 12/01/2022]
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Scotti A, Taramasso M, Adamo M, Russo M, Chiarito M, Melillo F, Beneduce A, Baldetti L, Pivato CA, Salerno A, Cappelletti A, Magni V, Stella S, Fragasso G, Montorfano M, Agricola E, Ettori F, Margonato A, Maisano F, Colombo A, Godino C. TCT-541 Multi-center experience of MitraClip therapy in patients with Ischaemic and Non-ischaemic Functional Mitral Regurgitation: 2-year outcomes. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.715] [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: 11/29/2022]
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Godino C, Scotti A, Taramasso M, Adamo M, Russo M, Pivato CA, Arrigoni L, Baldetti L, Bellini B, Cappelletti A, Stella S, Fragasso G, Montorfano M, Agricola E, Margonato A, Maisano F, Ettori F, Colombo A. TCT-542 Incidence and Predictors of Left Ventricular Negative Remodeling after MitraClip treatment in patients with Functional Mitral Regurgitation. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Godino C, Baldetti L, Giannattasio A, Munafò A, Pivato CA, Scotti A, Beneduce A, Perfetti G, Cappelletti A, Magni V, Carlino M, Margonato A, Colombo A. TCT-109 Ten-year clinical outcome in patients with Coronary Chronic Total Occlusions not revascularized by Percutaneous Coronary Intervention. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.165] [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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