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Giacoppo D. Untangling the knot of the best endovascular treatment for femoropopliteal artery disease. Int J Cardiol 2024; 407:132108. [PMID: 38692491 DOI: 10.1016/j.ijcard.2024.132108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Daniele Giacoppo
- Division of Cardiology, Policlinico "Rodolico-San Marco", Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
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Giacoppo D, Mazzone PM, Capodanno D. Current Management of In-Stent Restenosis. J Clin Med 2024; 13:2377. [PMID: 38673650 PMCID: PMC11050960 DOI: 10.3390/jcm13082377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
In-stent restenosis (ISR) remains the primary cause of target lesion failure following percutaneous coronary intervention (PCI), resulting in 10-year incidences of target lesion revascularization at a rate of approximately 20%. The treatment of ISR is challenging due to its inherent propensity for recurrence and varying susceptibility to available strategies, influenced by a complex interplay between clinical and lesion-specific conditions. Given the multiple mechanisms contributing to the development of ISR, proper identification of the underlying substrate, especially by using intravascular imaging, becomes pivotal as it can indicate distinct therapeutic requirements. Among standalone treatments, drug-coated balloon (DCB) angioplasty and drug-eluting stent (DES) implantation have been the most effective. The main advantage of a DCB-based approach is the avoidance of an additional metallic layer, which may otherwise enhance neointimal hyperplasia, provide the substratum for developing neoatherosclerosis, and expose the patient to a persistently higher risk of coronary ischemic events. On the other hand, target vessel scaffolding by DES implantation confers relevant mechanical advantages over DCB angioplasty, generally resulting in larger luminal gain, while drug elution from the stent surface ensures the inhibition of neointimal hyperplasia. Nevertheless, repeat stenting with DES also implies an additional permanent metallic layer that may reiterate and promote the mechanisms leading to ISR. Against this background, the selection of either DCB or DES on a patient- and lesion-specific basis as well as the implementation of adjuvant treatments, including cutting/scoring balloons, intravascular lithotripsy, and rotational atherectomy, hold the potential to improve the effectiveness of ISR treatment over time. In this review, we comprehensively assessed the available evidence from randomized trials to define contemporary interventional treatment of ISR and provide insights for future directions.
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Affiliation(s)
- Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico—San Marco”, Department of Surgery and Medical-Surgical Specialties, University of Catania, via Santa Sofia 78, 95124 Catania, Italy (D.C.)
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Giacoppo D, Laudani C, Occhipinti G, Spagnolo M, Greco A, Rochira C, Agnello F, Landolina D, Mauro MS, Finocchiaro S, Mazzone PM, Ammirabile N, Imbesi A, Raffo C, Buccheri S, Capodanno D. Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis. Circulation 2024; 149:1065-1086. [PMID: 38344859 PMCID: PMC10980178 DOI: 10.1161/circulationaha.123.067583] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)- and optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with invasive coronary angiography (ICA)-guided PCI as well as a pivotal trial comparing the 2 intravascular imaging (IVI) techniques have provided mixed results. METHODS Major electronic databases were searched to identify eligible trials evaluating at least 2 PCI guidance strategies among ICA, IVUS, and OCT. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. Frequentist random-effects network meta-analyses were conducted. The results were replicated by Bayesian random-effects models. Pairwise meta-analyses of the direct components, multiple sensitivity analyses, and pairwise meta-analyses IVI versus ICA were supplemented. RESULTS The results from 24 randomized trials (15 489 patients: IVUS versus ICA, 46.4%, 7189 patients; OCT versus ICA, 32.1%, 4976 patients; OCT versus IVUS, 21.4%, 3324 patients) were included in the network meta-analyses. IVUS was associated with reduced target lesion revascularization compared with ICA (odds ratio [OR], 0.69 [95% CI, 0.54-0.87]), whereas no significant differences were observed between OCT and ICA (OR, 0.83 [95% CI, 0.63-1.09]) and OCT and IVUS (OR, 1.21 [95% CI, 0.88-1.66]). Myocardial infarction did not significantly differ between guidance strategies (IVUS versus ICA: OR, 0.91 [95% CI, 0.70-1.19]; OCT versus ICA: OR, 0.87 [95% CI, 0.68-1.11]; OCT versus IVUS: OR, 0.96 [95% CI, 0.69-1.33]). These results were consistent with the secondary outcomes of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and target vessel revascularization, and sensitivity analyses generally did not reveal inconsistency. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26-0.92]) but only in the frequentist analysis. Similarly, the results in terms of survival between IVUS or OCT and ICA were uncertain across analyses. A total of 25 randomized trials (17 128 patients) were included in the pairwise meta-analyses IVI versus ICA where IVI guidance was associated with reduced target lesion revascularization, cardiac death, and stent thrombosis. CONCLUSIONS IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.
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Affiliation(s)
- Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Carmelo Raffo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Sergio Buccheri
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “Rodolico – San Marco,” University of Catania, Italy
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Tanner R, Giacoppo D, Saber H, Barton D, Sugrue D, Roy A, Blake G, Spence MS, Margey R, Casserly IP. Trends in transcatheter aortic valve implantation practice and clinical outcomes at an Irish tertiary referral centre. Open Heart 2024; 11:e002610. [PMID: 38538065 PMCID: PMC10982748 DOI: 10.1136/openhrt-2024-002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE A paucity of data exists on how transcatheter aortic valve implantation (TAVI) practice has evolved in Ireland. This study sought to analyse temporal trends in patient demographics, procedural characteristics, and clinical outcomes at an Irish tertiary referral centre. METHODS The prospective Mater TAVI database was divided into time tertiles based on when TAVI was performed: Group A, November 2008-April 2013; Group B, April 2013-September 2017; and Group C, September 2017-February 2022. Patient and procedural characteristics and clinical outcomes were compared across groups. RESULTS A total of 1063 (Group A, 59; Group B, 268; and Group C:, 736) patients were treated with TAVI during the study period (mean age 81.1±7.4, mean Society of Thoracic Surgeons score 5.9±5.1).Conscious sedation (Group A, 0%; Group B, 59.9%; and Group C, 90.2%, p<0.001) and femoral artery access (Group A, 76.3%; Group B, 90.7%; and Group C, 96.6%, p<0.001) were used more frequently over time. The median length of hospital stay reduced from 9 days (IQR 7, 18) in Group A to 2 days (IQR 2, 3) in Group C. In-hospital death was numerically higher in Group A compared with Group C (6.8% vs 1.9%, p=0.078). At 1-year follow-up, the rate of death and/or stroke was similar in Group A and Group C (20.3% vs 12.0%, adjusted HR 1.49, 95% CI (0.59 to 3.74)). CONCLUSION There was exponential growth in TAVI procedural volume during the study period. A minimalist approach to TAVI emerged, and this was associated with significantly shorter procedure duration and hospital stay. Clinical outcomes at 1-year follow-up did not change significantly over time.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Hassan Saber
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - David Barton
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Declan Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Andrew Roy
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Mark S Spence
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ronan Margey
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
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Occhipinti G, Laudani C, Spagnolo M, Finocchiaro S, Mazzone PM, Faro DC, Mauro MS, Rochira C, Agnello F, Giacoppo D, Ammirabile N, Landolina D, Imbesi A, Sangiorgio G, Greco A, Capodanno D. Pharmacological and Clinical Appraisal of Factor XI Inhibitor Drugs. Eur Heart J Cardiovasc Pharmacother 2024:pvae002. [PMID: 38196141 DOI: 10.1093/ehjcvp/pvae002] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The evolution of anticoagulation therapy, from vitamin K antagonists to the advent of direct oral anticoagulants (DOACs) almost two decades ago, marks significant progress. Despite improved safety demonstrated in pivotal trials and post-marketing observations, persistent concerns exist, particularly regarding bleeding risk and the absence of therapeutic indications in specific subgroups or clinical contexts. Factor XI (FXI) has recently emerged as a pivotal contributor to intraluminal thrombus formation and growth, playing a limited role in sealing vessel wall injuries. Inhibiting FXI presents an opportunity to decouple thrombosis from hemostasis, addressing concerns related to bleeding events while safeguarding against thromboembolic events. Notably, FXI inhibition holds promise for patients with end-stage renal disease or cancer, where clear indications for DOACs are currently lacking. Various compounds have undergone design, testing, and progression to phase 2 clinical trials, demonstrating a generally favorable safety and tolerability profile. However, validation through large-scale phase 3 trials with sufficient power to assess both safety and efficacy outcomes is needed. This review comprehensively examines FXI inhibitors, delving into individual classes, exploring their pharmacological properties, evaluating the latest evidence from randomized trials, and offering insights into future perspectives.
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Affiliation(s)
- Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Denise Cristiana Faro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Giuseppe Sangiorgio
- Department of Biomedical and biotechnological sciences, University of Catania, Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Agnello F, Mauro MS, Rochira C, Landolina D, Finocchiaro S, Greco A, Ammirabile N, Raffo C, Mazzone PM, Spagnolo M, Occhipinti G, Imbesi A, Giacoppo D, Capodanno D. PCSK9 inhibitors: current status and emerging frontiers in lipid control. Expert Rev Cardiovasc Ther 2024; 22:41-58. [PMID: 37996219 DOI: 10.1080/14779072.2023.2288169] [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: 09/03/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of global mortality, imposing substantial healthcare economic burdens. Among the modifiable risk factors, hypercholesterolemia, especially elevated low-density lipoprotein cholesterol (LDL-C), plays a pivotal role in ASCVD development. Novel therapies such as PCSK9 (Proprotein Convertase Subtilisin/Kexin type 9) inhibitors are emerging to address this concern. These inhibitors offer the potential to reduce ASCVD risk by directly targeting LDL-C levels. AREAS COVERED The article reviews the structural and functional aspects of PCSK9, highlighting its role in LDL receptor regulation. The pharmacological strategies for PCSK9 inhibition, including monoclonal antibodies, binding peptides, gene silencing, and active immunization, are explored. Clinical evidence from various trials underscores the safety and efficacy of PCSK9 inhibitors in reducing LDL-C levels and potentially improving cardiovascular outcomes. Despite these promising results, challenges such as cost-effectiveness and long-term safety considerations are addressed. EXPERT OPINION Among PCSK9 inhibitors, monoclonal antibodies represent a cornerstone. Many trials have showed their efficacy in reducing LDL-C and the risk for major adverse clinical events, revealing long-lasting effects, with special benefits particularly for statin-intolerant and familial hypercholesterolemia patients. However, long-term impacts, high costs, and patient selection necessitate further research.
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Affiliation(s)
- Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carmelo Raffo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Gargiulo G, Giacoppo D. Should we routinely use ultrasound-guided transfemoral access for coronary procedures? High-quality evidence from an individual participant data meta-analysis. EUROINTERVENTION 2024; 20:21-23. [PMID: 38165108 PMCID: PMC10756219 DOI: 10.4244/eij-e-23-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Daniele Giacoppo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Greco A, Occhipinti G, Giacoppo D, Agnello F, Laudani C, Spagnolo M, Mauro MS, Rochira C, Finocchiaro S, Mazzone PM, Faro DC, Landolina D, Ammirabile N, Imbesi A, Raffo C, Capodanno D. Antithrombotic Therapy for Primary and Secondary Prevention of Ischemic Stroke: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1538-1557. [PMID: 37793752 DOI: 10.1016/j.jacc.2023.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 10/06/2023]
Abstract
Stroke is a devastating condition with significant morbidity and mortality worldwide. Antithrombotic therapy plays a crucial role in both primary and secondary prevention of stroke events. Single or dual antiplatelet therapy is generally preferred in cases of large-artery atherosclerosis and small-vessel disease, whereas anticoagulation is recommended in conditions of blood stasis or hypercoagulable states that mostly result in red thrombi. However, the benefit of antithrombotic therapies must be weighed against the increased risk of bleeding, which can pose significant challenges in the pharmacological management of this condition. This review provides a comprehensive summary of the currently available evidence on antithrombotic therapy for ischemic stroke and outlines an updated therapeutic algorithm to support physicians in tailoring the strategy to the individual patient and the underlying mechanism of stroke.
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Affiliation(s)
- Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy. https://twitter.com/AGrecoMD
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Daniele Giacoppo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Denise Cristiana Faro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Carmelo Raffo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy.
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Escaned J, Berry C, De Bruyne B, Shabbir A, Collet C, Lee JM, Appelman Y, Barbato E, Biscaglia S, Buszman PP, Campo G, Chieffo A, Colleran R, Collison D, Davies J, Giacoppo D, Holm NR, Jeremias A, Paradies V, Piróth Z, Raposo L, Roguin A, Rudolph T, Sarno G, Sen S, Toth GG, Van Belle E, Zimmermann FM, Dudek D, Stefanini G, Tarantini G. Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology. EUROINTERVENTION 2023; 19:464-481. [PMID: 37171503 PMCID: PMC10436072 DOI: 10.4244/eij-d-23-00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yolande Appelman
- Amsterdam UMC, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Piotr P Buszman
- Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- American Heart of Poland, Ustroń, Poland
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Róisín Colleran
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Justin Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Daniele Giacoppo
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
- ISAResearch, German Heart Centre Munich, Munich, Germany
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Luís Raposo
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Giovanna Sarno
- Cardiology, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Lille, France
- Department of Cardiology, Institut Pasteur de Lille, Lille, France
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- University of Padua Medical School, Padua, Italy
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10
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Giacoppo D, Alvarez-Covarrubias HA, Koch T, Cassese S, Xhepa E, Kessler T, Wiebe J, Joner M, Hochholzer W, Laugwitz KL, Schunkert H, Kastrati A, Kufner S. Coronary artery restenosis treatment with plain balloon, drug-coated balloon, or drug-eluting stent: 10-year outcomes of the ISAR-DESIRE 3 trial. Eur Heart J 2023; 44:1343-1357. [PMID: 36807512 DOI: 10.1093/eurheartj/ehad026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 12/09/2022] [Accepted: 01/11/2023] [Indexed: 02/23/2023] Open
Abstract
AIMS The best interventional strategy for the treatment of drug-eluting stent (DES) in-stent restenosis (ISR) is still unclear and no data from randomized trials beyond 3-year follow-up are available. We aimed to define 10-year comparative efficacy and safety of plain balloon (PB), paclitaxel-coated balloon (PCB), and paclitaxel-eluting stent (PES) for percutaneous coronary intervention (PCI) of DES-ISR. METHODS AND RESULTS Clinical follow-up of patients randomly assigned to PB, PCB, and PES in the ISAR-DESIRE 3 trial was extended to 10 years and events were independently adjudicated. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction, target lesion thrombosis, or target lesion revascularization. The major secondary safety endpoint was a composite of cardiac death, target vessel myocardial infarction, or target lesion thrombosis. The major secondary efficacy endpoint was target lesion revascularization. Incidences by the Kaplan-Meier method were compared by the log-rank test. Risk estimation was primarily performed by Cox proportional hazards regression and supplemented by weighted Cox regression accounting for non-proportional hazards and Royston-Parmar flexible parametric regression with a time-varying coefficient. Primary results were further assessed by landmark, lesion-level, per-protocol, and competing risk analyses. A total of 402 patients (500 lesions) with DES-ISR were randomly assigned to PB angioplasty (134 patients, 160 lesions), PCB angioplasty (137 patients, 172 lesions), and PES implantation (131 patients, 168 lesions). Clinical follow-up did not significantly differ among treatments [PB, 9.62 (4.50-10.02) years; PCB, 10.01 (5.72-10.02) years; PES, 9.08 (3.14-10.02) years; P = 0.300]. At 10 years, the primary composite endpoint occurred in 90 patients (72.0%) assigned to PB, 70 patients (55.9%) assigned to PCB, and 72 patients (62.4%) assigned to PES (P < 0.001). The pairwise comparison between PCB and PES resulted in a non-significant difference [multiplicity-adjusted P = 0.610; Grambsch-Therneau P = 0.004; weighted Cox: hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.80-1.51; Cox: HR 1.10, 95% CI 0.79-1.52; Royston-Parmar: HR 1.08, 95% CI 0.72-1.60]. The major secondary safety endpoint occurred in 39 patients (34.1%) assigned to PB, 39 patients (34.0%) assigned to PCB, and 42 patients (40.0%) assigned to PES (P = 0.564). Target lesion revascularization occurred in 71 patients (58.0%) assigned to PB, 55 patients (43.9%) assigned to PCB, and 42 patients (38.6%) assigned to PES (P < 0.0001). The pairwise comparison between PES and PCB resulted in a non-significant difference (multiplicity-adjusted P = 0.282; Grambsch-Therneau P = 0.002; weighted Cox: HR 0.83, 95% CI 0.56-1.22; Cox: HR 0.81, 95% CI 0.54-1.21; Royston-Parmar: HR 0.75, 95% CI 0.47-1.20). Lesion-level and per-protocol analyses were consistent. At landmark analyses, an excess of death and cardiac death associated with PES compared with PCB was observed within 5 years after PCI, though 10-year differences did not formally reach the threshold of statistical significance after adjustment for multiplicity. Competing risk regression confirmed a non-significant difference in target lesion revascularization between PCB and PES and showed an increased risk of death associated with PES compared with PCB. CONCLUSION Ten years after PCI for DES-ISR, the primary and major secondary endpoints between PCB and PES were not significantly different. However, an excess of death and cardiac death within 5 years associated with PES and the results of the competing risk analysis are challenging to interpret and warrant further analysis. PES and PCB significantly reduced target lesion revascularization compared with PB.
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Affiliation(s)
- Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,Cardiovascular Research Institute Dublin, Mater Private Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
| | - Hector A Alvarez-Covarrubias
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, IMSS, Ciudad de Mexico, Mexico
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Willibald Hochholzer
- Department of Cardiology, Universitätsherzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany.,Department of Cardiology and Intensive Care Medicine, Klinikum Würzburg Mitte, Würzburg, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie und Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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11
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Gargiulo G, Giacoppo D, Jolly SS, Cairns J, Le May M, Bernat I, Romagnoli E, Rao SV, van Leeuwen MAH, Mehta SR, Bertand OF, Wells GA, Meijers TA, Siontis GCM, Esposito G, Windecker S, Jüni P, Valgimigli M. Impact on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: a Meta-analysis of Individual Patient Data from Seven Multicenter Randomized Clinical Trials. Circulation 2022; 146:1329-1343. [PMID: 36036610 DOI: 10.1161/circulationaha.122.061527] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In some randomized controlled trials (RCTs), transradial (TRA) compared with transfemoral access (TFA) was associated with lower mortality in coronary artery disease patients undergoing invasive management. We analyzed the effects of TRA versus TFA across multicenter RCTs and whether these associations are modified by patient or operator characteristics. METHODS We performed an individual patient data meta-analysis of multicenter RCTs comparing TRA versus TFA among patients undergoing coronary angiography with or without percutaneous coronary intervention (PCI) (PROSPERO; CRD42018109664). The primary outcome was all-cause mortality and the co-primary outcome was major bleeding at 30 days. The primary analysis was conducted by one-stage mixed-effects models based on the intention-to-treat cohort. The impact of access-site on mortality and major bleeding was further assessed by multivariable analysis. The relationship among access-site, bleeding, and mortality was investigated by natural effect model mediation analysis with multivariable adjustment. RESULTS A total of 21,600 patients (TRA=10,775 vs. TFA=10,825) from 7 RCTs were included. Median age was 63.9 years, 31.9% were female, 95% presented with acute coronary syndrome (ACS), and 75.2% underwent PCI. All-cause mortality (1.6% vs. 2.1%; HR 0.77, 95% CI 0.63-0.95, p=0.012) and major bleeding (1.5% vs. 2.7%; OR 0.55, 95% CI 0.45- 0.67, p<0.001) were lower with TRA. Subgroup analyses for mortality showed consistent results, except for baseline hemoglobin (pinteraction=0.033), indicating that the benefit of TRA was substantial in patients with significant anemia, while it was not significant in patients with milder or no baseline anemia. After adjustment, TRA remained associated with 24% and 51% relative risk reduction of all-cause mortality and major bleeding. A mediation analysis showed that the benefit of TRA on mortality was only partially driven by major bleeding prevention, and ancillary mechanisms are required to fully explain the causal association. CONCLUSIONS TRA is associated with lower all-cause mortality and major bleeding at 30 days, compared with TFA. The effect on mortality was driven by patients with anemia. The reduction in major bleeding only partially explains the mortality benefit.
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Affiliation(s)
- Giuseppe Gargiulo
- 1Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Daniele Giacoppo
- Cardiology Department, Alto Vicentino Hospital, Santorso, Italy; 3Cardiovascular Research Institute, Mater Private Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland; ISAResearch Center, Deutsches Herzzentrum München, Technisches Universität München, Munich, Germany
| | - Sanjit S Jolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - John Cairns
- University of British Columbia, Vancouver, Canada
| | - Michel Le May
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ivo Bernat
- University Hospital and Faculty of Medicine Pilsen, Charles University, Czech Republic
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC
| | | | - Shamir R Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | - George A Wells
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Stephan Windecker
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marco Valgimigli
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
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12
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Abstract
In-stent restenosis (ISR) remains the most common cause of stent failure after percutaneous coronary intervention (PCI). Recent data suggest that ISR-PCI accounts for 5-10% of all PCI procedures performed in current clinical practice. This State-of-the-Art review will primarily focus on the management of ISR but will begin by briefly discussing diagnosis and classification. We then move on to detail the evidence base underpinning the various therapeutic strategies for ISR before finishing with a proposed ISR management algorithm based on current scientific data.
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Calle de Diego de León 62, 28006 Madrid, Spain
| | - J. J. Coughlan
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
| | - Adnan Kastrati
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A. Byrne
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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13
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Blake N, Alonso A, Rai H, Colleran R, Giacoppo D, Byrne RA. A meta-analysis of randomised controlled trials investigating the impact of colchicine on major adverse cardiovascular events in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1221] [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/Introduction
Colchicine has been shown to reduce inflammation and has a potential to stabilise atherosclerotic plaques. Prior meta-analyses on the topic suggest its role in reducing components of major adverse cardiovascular events (MACE).
Purpose
The aim of the present meta-analysis was to delineate the effect of colchicine on post-PCI (percutaneous intervention) MACE among acute coronary syndrome (ACS) patients.
Methods
We included randomised controlled trials (RCTs) comparing colchicine to placebo in ACS patients undergoing PCI. To identify potentially relevant trials a PUBMED search was undertaken using the MESH terms “colchicine” and “cardiovascular system”. Eligible RCTs published up to November 2020 were included. Our search strategy also included presentations from the proceedings of international meetings. The primary endpoint was MACE. However, definitions of MACE varied between included studies. Study level odds ratios (ORs) and 95% confidence intervals (CI) of MACE were pooled using the Mantel-Haenszel method and random effects model. Forest plots were generated using Review Manager (RevMan) 5.4 software.
Results
Our initial search identified 1,049 articles for potential inclusion. Of them, 4 RCTs were found to be eligible: COPS, COLCHICINE-PCI, COLCOT time-to-Initiation (TTI) 0–3 days and PODCAST-PCI.
A pool of 2,709 patients were randomly allocated to treatment with either colchicine (n=1,367) or placebo (n=1,342). Patients received colchicine either prior to angiography or within 3 days post-procedure. Follow up duration ranged from 30 days to 3 years during which MACE were recorded. Mean age of the whole analysed cohort was 60.3±10.5 years. 73% were male. 51% had history of hypertension, 26% had diabetes mellitus, 38% were current smokers. There were 89 events in the colchicine group as opposed to 133 events in the placebo group. The risk of post-PCI MACE was lower in patients treated with colchicine as compared with placebo (OR 0.63, 95% CI 0.48–0.84, p=0.001) (see figure 1). Heterogeneity was not detectable (I2=0).
Conclusions
Our results indicate lower risk of MACE in patients treated with colchicine. This indicates a potential use of colchicine in patients undergoing PCI in an ACS setting. Further investigations in larger cohorts are warranted to test this effect.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- N Blake
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
| | - A Alonso
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
| | - H Rai
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
| | - R Colleran
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
| | - D Giacoppo
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
| | - R A Byrne
- Mater Private Hospital, Cardiovascular Research Institute Dublin, Dublin, Ireland
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14
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Michel JM, Frangieh AH, Giacoppo D, Alvarez-Covarrubias HA, Pellegrini C, Rheude T, Deutsch O, Mayr NP, Rumpf PM, Stähli BE, Kastrati A, Schunkert H, Xhepa E, Joner M, Kasel AM. Safety and efficacy of minimalist transcatheter aortic valve implantation using a new-generation balloon-expandable transcatheter heart valve in bicuspid and tricuspid aortic valves. Clin Res Cardiol 2021; 110:1993-2006. [PMID: 34505192 DOI: 10.1007/s00392-021-01935-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/30/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bicuspid aortic valve may be associated with increased complications during transcatheter aortic valve implantation (TAVI). AIMS Compare balloon-expandable transcatheter heart valve (THV) safety and efficacy in severe tricuspid (TAV) and bicuspid (BAV) aortic stenosis. METHODS Transfemoral TAVI was performed in 743 patients (Jan 2014-June 2019) using the SAPIEN 3 THV. Aortic valve morphology was determined using computed tomography. Valve Academic Research Consortium-2 (VARC-2) derived safety and efficacy endpoints at 1 year were evaluated. RESULTS BAV patients (n = 78), were younger (77 [72, 81] vs. 81 [78, 85] years, p < 0.001) with lower surgical risk (EuroSCORE II 2.96% vs. 4.51% p < 0.001). Bicuspid valves were more calcified (BAV 1308mm3, TAV 848mm3 p < 0.001) with more asymmetric calcification (BAV 63/78 (81%), TAV 239/665 (36%), p < 0.001). Device success (BAV 94%, TAV 90%, p = 0.45) and major vascular complications (BAV 6%, TAV 9%, p = 0.66) were comparable. At 1 year, there was a trend toward lower combined all-cause mortality and rehospitalization for congestive heart failure in BAV patients (BAV 7%, TAV 13%, p = 0.08) with significantly lower all-cause mortality in this cohort (BAV 1%, TAV 9%, p = 0.020). VARC-2 time-related valve safety (BAV 22%, TAV 20%, p = 0.60) was comparable; however, bioprosthetic valve thrombosis remained more common in BAV patients (BAV 7%, TAV 2%, p = 0.010, Hazard ratio 3.57 [95% confidence interval 1.26, 10.10]). After propensity score matching, only bioprosthetic valve thrombosis remained significantly different. CONCLUSIONS Safety and efficacy of the SAPIEN 3 balloon-expandable THV in BAV is comparable with TAV. Higher rates of bioprosthetic valve thrombosis require further investigation.
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Affiliation(s)
- Jonathan M Michel
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Antonio H Frangieh
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, Hôtel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Daniele Giacoppo
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy.,Department of Cardiac-Thoracic-Vascular Sciences, University of Padua, Padua, Italy.,Cardiovascular Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hector A Alvarez-Covarrubias
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Tobias Rheude
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Oliver Deutsch
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - N Patrick Mayr
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - P Moritz Rumpf
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Adnan Kastrati
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Michael Joner
- German Heart Centre Munich, Technical University Munich, Munich, Germany.,Deutsches Zentrum Für Herz- Und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - A Markus Kasel
- German Heart Centre Munich, Technical University Munich, Munich, Germany. .,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
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Lahu S, Bristot P, Gewalt S, Goedel A, Giacoppo D, Schüpke S, Schunkert H, Kastrati A, Sarafoff N. Meta-Analysis of Short vs. Prolonged Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation and Role of Continuation with either Aspirin or a P2Y 12 Inhibitor Thereafter. J Atheroscler Thromb 2021; 29:1001-1019. [PMID: 34248087 PMCID: PMC9252616 DOI: 10.5551/jat.63000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an ongoing debate and novel data has emerged. The aim of this meta-analysis was to assess outcomes of short vs. control DAPT duration. In addition, the role of single antiplatelet therapy (SAPT) after DAPT with either aspirin or P2Y12 monotherapy was analyzed. METHODS The authors searched MEDLINE and Cochrane databases and proceedings of international meetings for randomized controlled trials (RCT) comparing ≤ 3 months with ≥ 6 months DAPT after DES implantation. The primary and co-primary outcomes of interest were definite or probable stent thrombosis (ST) and bleeding. In addition, we performed an analysis on studies who continued with either aspirin or P2Y12 monotherapy after DAPT. RESULTS 9 RCTs comprising 41,864 patients were included and we analyzed a short DAPT duration of median 1.5 months vs. 12.1 months in the control group. The risk for ST was similar with short vs. control DAPT duration (0.5 vs. 0.5%; hazard ratio 1.17[95% CI 0.89-1.54]; p=0.26). Bleeding was significantly reduced with short vs. control DAPT duration (1.9 vs. 3.0%; 0.65[0.54-0.77]; p<0.0001). ST was not different between short vs. control DAPT duration in the analysis of the 4 RCTs who continued with aspirin after DAPT and the 5 P2Y12 RCTs, respectively, and no heterogeneity was detected (p=0.861). Bleeding was also reduced with short vs. control DAPT in both the aspirin (1.2 vs. 1.7%; 0.71[0.51-0.99]; p=0.04) and P2Y12 inhibitor studies (2.1 vs. 3.4%; 0.62[0.47-0.80]; p=0.0003) and no heterogeneity was detected (p=0.515). CONCLUSIONS Our meta-analysis shows that short DAPT ≤ 3 months followed by SAPT reduces bleeding and is not associated with an increase in ST. The results were consistent within the aspirin and P2Y12 SAPT studies.
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Affiliation(s)
- Shqipdona Lahu
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Peter Bristot
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Senta Gewalt
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Alexander Goedel
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Munich
| | - Daniele Giacoppo
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Stefanie Schüpke
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Heribert Schunkert
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich.,Deutsches Zentrum fuer Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich
| | - Adnan Kastrati
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich.,Deutsches Zentrum fuer Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich
| | - Nikolaus Sarafoff
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
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16
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Giacoppo D, Matsuda Y, Fovino LN, D'Amico G, Gargiulo G, Byrne RA, Capodanno D, Valgimigli M, Mehran R, Tarantini G. Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials. Eur Heart J 2021; 42:308-319. [PMID: 33284979 DOI: 10.1093/eurheartj/ehaa739] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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: 05/06/2020] [Revised: 06/26/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear. METHODS AND RESULTS Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45-0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86-1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70-1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89-1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68-1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48-0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens. CONCLUSION After second-generation DES implantation, 1-3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation.
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Affiliation(s)
- Daniele Giacoppo
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padua, Italy.,Department of Cardiology, ISAResearch, German Heart Center, Lazarettstrasse 36, 80636 Munich, Germany.,Cardiovascular Research Institute, Mater Private Hospital, Eccles Street 73, Dublin 7, D07 WKW8, Ireland
| | - Yuji Matsuda
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padua, Italy.,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Luca Nai Fovino
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Gianpiero D'Amico
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Robert A Byrne
- Cardiovascular Research Institute, Mater Private Hospital, Eccles Street 73, Dublin 7, D07 WKW8, Ireland.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Saint Peter's, Dublin 2, D02 YN77, Ireland
| | - Davide Capodanno
- Department of Cardiology, Policlinico "Rodolico-San Marco", University of Catania, Via S. Sofia 78, 95125 Catania, Italy
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Bern, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.,Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Giuseppe Tarantini
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
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17
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Giacoppo D, Alfonso F, Xu B, Claessen BEPM, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Schunkert H, Colleran R, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JPS, Kastrati A, Byrne RA. Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study). Eur Heart J 2021; 41:3715-3728. [PMID: 31511862 PMCID: PMC7706792 DOI: 10.1093/eurheartj/ehz594] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/26/2019] [Accepted: 08/08/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Aims
Consensus is lacking regarding the best treatment for coronary in-stent restenosis (ISR). The two most effective treatments are angioplasty with paclitaxel-coated balloon (PCB) and repeat stenting with drug-eluting stent (DES) but individual trials were not statistically powered for clinical endpoints, results were heterogeneous, and evidence about comparative efficacy and safety in relevant subsets was limited.
Methods and results
The Difference in Anti-restenotic Effectiveness of Drug-eluting stent and drug-coated balloon AngiopLasty for the occUrrence of coronary in-Stent restenosis (DAEDALUS) study was a comprehensive, investigator-initiated, collaborative, individual patient data meta-analysis comparing angioplasty with PCB alone vs. repeat stenting with DES alone for the treatment of coronary ISR. The protocol was registered with PROSPERO (CRD42017075007). All 10 available randomized clinical trials were included with 1976 patients enrolled, 1033 assigned to PCB and 943 to DES. At 3-year follow-up, PCB was associated with a significant increase in the risk of target lesion revascularization (TLR) compared with DES [hazard ratio (HR) 1.32, 95% CI 1.02–1.70, P = 0.035; number-needed-to-harm 28.5]. There was a significant interaction between treatment effect and type of restenosed stent (P = 0.029) with a more marked difference in patients with DES-ISR and comparable effects in patients with bare-metal stent-ISR. At 3-year follow-up, the primary safety endpoint of all-cause death, myocardial infarction, or target lesion thrombosis was comparable between treatments (HR 0.80, 95% CI 0.58–1.09, P = 0.152). A pre-specified subgroup analysis indicated a significant interaction between treatment effect and type of DES used to treat ISR (P = 0.033), with a lower incidence of events associated with PCB compared with first-generation DES and similar effect between PCB and second-generation DES (HR 1.06, 95% CI 0.71–1.60, P = 0.764). Long-term all-cause mortality was similar between PCB and DES (HR 0.81, 95% CI 0.53–1.22, P = 0.310); results were consistent comparing PCB and non-paclitaxel-based DES (HR 1.42, 95% CI 0.80–2.54, P = 0.235). Myocardial infarction and target lesion thrombosis were comparable between treatments.
Conclusions
In patients with coronary ISR, repeat stenting with DES is moderately more effective than angioplasty with PCB at reducing the need for TLR at 3 years. The incidence of a composite of all-cause death, myocardial infarction, or target lesion thrombosis was similar between groups. The rates of individual endpoints, including all-cause mortality, were not significantly different between groups.
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Affiliation(s)
- Daniele Giacoppo
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Bo Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Bimmer E P M Claessen
- Mount Sinai Heart, the Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, 10029 New York, NY, USA
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christoph Jensen
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - María J Pérez-Vizcayno
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Ralf Degenhardt
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany
| | - Leos Pleva
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Jan Baan
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Heribert Schunkert
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Roisin Colleran
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Pavel Kukla
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Martin Unverdorben
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.,Daiichi Sankyo, 211 Mt. Airy Road, 07920 Basking Ridge, NJ, USA
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Christoph K Naber
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - José P S Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Robert A Byrne
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
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18
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Michel JM, Hashorva D, Kretschmer A, Alvarez-Covarrubias HA, Mayr NP, Pellegrini C, Rheude T, Frangieh AH, Giacoppo D, Kastrati A, Schunkert H, Xhepa E, Joner M, Kasel AM. Evaluation of a Low-Dose Radiation Protocol During Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 139:71-78. [PMID: 33190811 DOI: 10.1016/j.amjcard.2020.10.035] [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: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of "fluoro save," 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm2, p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm2 reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes.
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19
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Stefanini GG, Alfonso F, Barbato E, Byrne R, Capodanno D, Colleran R, Escaned J, Giacoppo D, Kunadian V, Lansky A, Mehilli J, Neumann FJ, Regazzoli D, Sanz-Sanchez J, Wijns W, Baumbach A. Management of myocardial revascularisation failure: an expert consensus document of the EAPCI. EUROINTERVENTION 2020; 16:e875-e890. [DOI: 10.4244/eij-d-20-00487] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Giacoppo D, Kastrati A, Byrne RA. Reply: Drug-Coated Balloons Versus Drug-Eluting Stents for Coronary In-Stent Restenosis. J Am Coll Cardiol 2020; 76:1392-1393. [PMID: 32912456 DOI: 10.1016/j.jacc.2020.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
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21
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Tarantini G, Giacoppo D. Transcatheter versus surgical aortic valve replacement in the digital era: Meta-analysis based on the reconstruction of time-to-event individual patient data. Catheter Cardiovasc Interv 2020; 96:167-168. [PMID: 32652837 DOI: 10.1002/ccd.29079] [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] [Received: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/07/2022]
Abstract
Clinical benefits of transcatheter aortic valve replacement (TAVR) over surgery emerge soon after intervention and show durable, consistent trends within 1 year. TAVR by transfemoral access is associated with improved outcomes compared with TAVR by transthoracic access. Reconstructing time-to-event individual patient data is advantageous and allows higher flexibility in terms of meta-analysis design and modeling of data.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac-Vascular-Thoracic Sciences, University of Padova, Padova, Italy
| | - Daniele Giacoppo
- Department of Cardiac-Vascular-Thoracic Sciences, University of Padova, Padova, Italy
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22
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Matsuda Y, Nai Fovino L, Giacoppo D, Scotti A, Massussi M, Ueshima D, Sasano T, Fabris T, Tarantini G. Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis. Catheter Cardiovasc Interv 2020; 97:E536-E543. [DOI: 10.1002/ccd.29105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daniele Giacoppo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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23
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Giacoppo D, Alfonso F, Xu B, Claessen BE, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JP, Kastrati A, Byrne RA. Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation in Patients With Coronary Stent Restenosis. J Am Coll Cardiol 2020; 75:2664-2678. [DOI: 10.1016/j.jacc.2020.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
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Giacoppo D, Tarantini G. Risk of stroke, atrial fibrillation, and major bleeding after mitral valve repair: the jury is still out. EUROINTERVENTION 2020; 15:1387-1389. [PMID: 32200344 DOI: 10.4244/eijv15i16a251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Daniele Giacoppo
- Cardiac-Thoracic-Vascular Department, University of Padua, Padua, Italy
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25
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Resultado del tratamiento percutáneo de la reestenosis de stents farmacoactivos: ¿depende de si el stent tenía o no recubrimiento polimérico? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.01.011] [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: 11/28/2022]
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26
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Ueshima D, Nai Fovino L, Brener SJ, Fabris T, Scotti A, Barioli A, Giacoppo D, Pavei A, Fraccaro C, Napodano M, Tarantini G. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: A systematic review and meta-analysis. Int J Cardiol 2020; 298:76-82. [DOI: 10.1016/j.ijcard.2019.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
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27
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Tarantini G, Giacoppo D. Acute kidney injury after endovascular interventions for critical limb ischemia: Is that a whole different animal? Catheter Cardiovasc Interv 2019; 94:642-643. [PMID: 31602800 DOI: 10.1002/ccd.28516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Daniele Giacoppo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Tarantini G, Giacoppo D. Radial artery access among mainstays of contemporary percutaneous coronary intervention: Is it time to forget how to puncture a femoral artery? Catheter Cardiovasc Interv 2019; 94:385-386. [PMID: 31670885 DOI: 10.1002/ccd.28487] [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] [Received: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022]
Abstract
Radial artery access should be the default approach for coronary angiography and percutaneous coronary intervention regardless of the clinical presentation. Benefits of radial access are strongly depending on the volume of transradial procedures performed. Currently, a significant proportion of procedures continues to be performed by femoral access despite validated advantages associated with the transradial approach.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padua, Padua, Italy
| | - Daniele Giacoppo
- Department of Cardiac-Thoracic-Vascular Sciences, University of Padua, Padua, Italy
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Giacoppo D, Colleran R, Cassese S, Frangieh AH, Wiebe J, Joner M, Schunkert H, Kastrati A, Byrne RA. Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis. JAMA Cardiol 2019; 2:1079-1088. [PMID: 28903139 DOI: 10.1001/jamacardio.2017.2895] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance In patients with left main coronary artery (LMCA) stenosis, coronary artery bypass grafting (CABG) has been the standard therapy for several decades. However, some studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative. Objective To compare the long-term safety of PCI with drug-eluting stent vs CABG in patients with LMCA stenosis. Data Sources PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect databases were searched from December 18, 2001, to February 1, 2017. Inclusion criteria were randomized clinical trial, patients with LMCA stenosis, PCI vs CABG, exclusive use of drug-eluting stents, and clinical follow-up of 3 or more years. Data Extraction and Synthesis Trial-level hazard ratios (HRs) and 95% CIs were pooled by fixed-effect and random-effects models with inverse variance weighting. Time-to-event individual patient data for the primary end point were reconstructed. Sensitivity analyses according to drug-eluting stent generation and coronary artery disease complexity were performed. Main Outcomes and Measures The primary end point was a composite of all-cause death, myocardial infarction, or stroke at long-term follow-up. Secondary end points included repeat revascularization and a composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at long-term follow-up. Results A total of 4 randomized clinical trials were pooled; 4394 patients were included in the analysis. Of these, 3371 (76.7%) were men; pooled mean age was 65.4 years. According to Grading of Recommendations, Assessment, Development and Evaluation, evidence quality with respect to the primary composite end point was high. Percutaneous coronary intervention and CABG were associated with a comparable risk of all-cause death, myocardial infarction, or stroke both by fixed-effect (HR, 1.06; 95% CI, 0.90-1.24; P = .48) and random-effects (HR, 1.06; 95% CI, 0.85-1.32; P = .60) analysis. Sensitivity analyses according to low to intermediate Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (random-effects: HR, 1.02; 95% CI, 0.74-1.41; P = .89) and drug-eluting stent generation (first generation: HR, 0.90; 95% CI, 0.68-1.20; P = .49; second generation: HR, 1.19; 95% CI, 0.82-1.73; P = .36) were consistent. Kaplan-Meier curve reconstruction did not show significant variations over time between the techniques, with a 5-year incidence of all-cause death, myocardial infarction, or stroke of 18.3% (319 events) in patients treated with PCI and 16.9% (292 events) in patients treated with CABG. However, repeat revascularization after PCI was increased (HR, 1.70; 95% CI, 1.42-2.05; P < .001). Other individual secondary end points did not differ significantly between groups. Finally, pooled estimates of trials with LMCA stenosis tended overall to differ significantly from those of trials with multivessel coronary artery disease without left main LMCA stenosis. Conclusions and Relevance Percutaneous coronary intervention and CABG show comparable safety in patients with LMCA stenosis and low to intermediate-complexity coronary artery disease. However, repeat revascularization is more common after PCI.
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Affiliation(s)
- Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonio H Frangieh
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Do outcomes following intervention for drug-eluting stent restenosis depend on whether the restenosed stent was polymer-free or polymer-coated? ACTA ACUST UNITED AC 2019; 73:225-231. [PMID: 30878234 DOI: 10.1016/j.rec.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Outcomes of patients undergoing percutaneous intervention for drug-eluting stent (DES) restenosis are poorer than those in patients with bare-metal stent restenosis. It is unknown if this is related to the presence of polymer coating. We sought to compare outcomes after interventions for in-stent restenosis (ISR) of polymer-free DES vs durable polymer DES. METHODS Patients enrolled in the ISAR-TEST 5 randomized trial who underwent repeat percutaneous intervention for ISR during follow-up were included. Angiographic outcomes at 6 to 8 months and clinical outcomes at 2 years were analyzed and compared between 2 groups according to whether the restenosed stent was a polymer-free or a durable polymer DES. Multivariate analysis was used to adjust for differences between groups. RESULTS A total of 326 patients with ISR were included: 220 with ISR in polymer-free DES and 106 with ISR in durable polymer DES. Angiographic follow-up was available for 83.4% of patients. No difference was observed in recurrent binary restenosis between the 2 groups (31.7% vs 27.0%; P=.38; Padjusted=.29). At 2 years, the composite of death, myocardial infarction, or repeat target lesion revascularization were similar between the 2 groups (35.7% vs 34.0%; HR=1.04, 95%CI, 0.70-1.55; P=.83; Padjusted=.79). The rate of repeat target lesion revascularization was also similar in the 2 groups (29.8% vs 31.5%; HR=0.91, 95%CI, 0.60-1.39; P=.68; Padjusted=.62). CONCLUSIONS In patients undergoing reintervention for DES-ISR, we found no evidence of differences in outcomes according to whether the restenosed stent was a polymer-free or durable polymer DES.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Janika Bohner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany.
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Giacoppo D. Impact of bystander-initiated cardiopulmonary resuscitation for out-of-hospital cardiac arrest: where would you be happy to have a cardiac arrest? Eur Heart J 2019; 40:319-321. [PMID: 30649371 DOI: 10.1093/eurheartj/ehy911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniele Giacoppo
- Cardiology Department, Deutsches Herzzentrum München, Munich, Germany
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Giacoppo D, Caronna N, Frangieh AH, Michel J, Andò G, Tarantini G, Kasel AM, Capodanno D, Byrne RA. Long-term effectiveness and safety of transcatheter closure of patent foramen ovale compared with antithrombotic therapy alone: a meta-analysis of six randomised clinical trials and 3,560 patients with reconstructed time-to-event data. EUROINTERVENTION 2018; 14:857-867. [DOI: 10.4244/eij-d-18-00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Giacoppo D, Alfonso F, Xu B, Claessen B, Adriaenssens T, Naber C, Perez-Vizcayno M, Kang DY, Degenhardt R, Pleva L, Baan J, Park DW, Gao R, Park SJ, Henriques JPS, Kastrati A, Byrne R. TCT-228 Outcomes After Treatment of Coronary In-Stent Restenosis With Drug-Coated Balloon Versus Drug-Eluting Stent According to the Presence or Absence of Diabetes Mellitus: A Prespecified Analysis of the DAEDALUS Study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1352] [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: 10/28/2022]
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Giacoppo D, Alfonso F, Xu B, Claessen B, Adriaenssens T, Naber C, Perez-Vizcayno MJ, Baan J, Degenhardt R, Pleva L, Fernandez C, Gao R, Henriques JP, Kastrati A, Byrne R. 1463Differential effectiveness of drug-coated balloon vs. drug-eluting stent for bare-metal or drug-eluting stent restenosis: a primary prespecified subanalysis from the DAEDALUS study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - B Xu
- Fu Wai Hospital, Beijing, China People's Republic of
| | - B Claessen
- Academic Medical Center, Amsterdam, Netherlands
| | | | - C Naber
- Contilia Heart and Vascular Center, Essen, Germany
| | | | - J Baan
- Academic Medical Center, Amsterdam, Netherlands
| | - R Degenhardt
- Heart and Vascular Center, Rotenburg an der Fulda, Germany
| | - L Pleva
- University Hospital Ostrava, Ostrava, Czech Republic
| | | | - R Gao
- Fu Wai Hospital, Beijing, China People's Republic of
| | | | | | - R Byrne
- German Heart Center, Munich, Germany
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Cassese S, Ndrepepa G, Byrne RA, Kufner S, Xhepa E, de Waha A, Rheude T, Colleran R, Giacoppo D, Harada Y, Laugwitz KL, Schunkert H, Fusaro M, Kastrati A. Outcomes of patients treated with durable polymer platinum-chromium everolimus-eluting stents: a meta-analysis of randomised trials. EUROINTERVENTION 2018; 13:986-993. [PMID: 28067198 DOI: 10.4244/eij-d-16-00871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The durable polymer platinum-chromium everolimus-eluting stent (PtCr-EES) is a new-generation drug-eluting stent (DES) with a platinum-enriched metallic platform developed to improve the percutaneous treatment of patients with coronary artery disease. We sought to investigate the performance of durable polymer PtCr-EES versus other new-generation DES. METHODS AND RESULTS We undertook a meta-analysis of trials in which patients receiving percutaneous coronary intervention (PCI) were randomly assigned to durable polymer PtCr-EES versus other new-generation DES (other DES). Primary efficacy and safety outcomes were target lesion revascularisation (TLR) and definite/probable stent thrombosis (ST), respectively. Secondary outcomes were myocardial infarction (MI), target vessel revascularisation (TVR), death, cardiac death and longitudinal stent deformation (LSD). A total of 11,036 patients in seven trials received a PCI with either durable polymer PtCr-EES (n=6,613) or other DES (n=4,423). This latter group comprised patients treated with biolimus- (n=325), cobalt-chromium everolimus- (n=1,940) or zotarolimus-eluting stents (n=2,158). After a median follow-up of 12 months (interquartile range 12-24), durable polymer PtCr-EES displayed a risk of TLR (odds ratio 0.98, 95% confidence interval [CI]: 0.75-1.29; p=0.90) and definite/probable ST (0.89 [0.55-1.45]; p=0.63) comparable to that of other DES. However, the durable polymer PtCr-EES was associated with a higher risk of LSD (12.05 [1.60-90.71], p=0.02) compared to other DES. There was no significant difference with regard to other secondary outcomes nor was there heterogeneity across trials. CONCLUSIONS At one-year follow-up, the durable polymer PtCr-EES displays a performance comparable to that of other new-generation DES platforms.
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Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Cassese S, Ndrepepa G, Kufner S, Byrne RA, Giacoppo D, Ott I, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. Drug-coated balloon angioplasty for in-stent restenosis of femoropopliteal arteries: a meta-analysis. EUROINTERVENTION 2018; 13:483-489. [PMID: 28169215 DOI: 10.4244/eij-d-16-00735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to perform a meta-analysis to investigate the outcomes of patients undergoing percutaneous revascularisation with drug-coated balloon (DCB) angioplasty because of femoropopliteal in-stent restenosis (ISR). METHODS AND RESULTS We searched scientific databases for studies of DCB angioplasty for femoropopliteal ISR. The primary outcome was target lesion revascularisation (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were Rutherford class (RC) improvement, ankle-brachial index (ABI) and death. A total of 367 patients enrolled in four studies received DCB (n=188) or plain balloon angioplasty (n=179). Median follow-up was 12 months. Patients treated with DCB angioplasty displayed a lower risk for TLR (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.07-0.55, p=0.002) and recurrent ISR (OR 0.24, 95% CI: 0.09-0.61, p=0.003), and a sustained RC improvement (OR 2.57, 95% CI: 1.40-4.72, p=0.002) with similar ABI and mortality as compared to those patients treated with plain balloon angioplasty. CONCLUSIONS In comparison to plain balloon angioplasty, DCB therapy for femoropopliteal ISR is associated with superior clinical and antirestenotic efficacy. Further randomised trials comparing DCB with therapies alternative to plain balloon, in a larger number of patients, and with extended follow-up are needed to address definitively the role of DCB for femoropopliteal ISR.
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Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Giacoppo D, Gargiulo G, Buccheri S, Aruta P, Byrne RA, Cassese S, Dangas G, Kastrati A, Mehran R, Tamburino C, Capodanno D. Preventive Strategies for Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Procedures: Evidence From a Hierarchical Bayesian Network Meta-Analysis of 124 Trials and 28 240 Patients. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004383. [PMID: 28487354 DOI: 10.1161/circinterventions.116.004383] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effectiveness of currently available effective preventive strategies for contrast-induced acute kidney injury (CIAKI) is a matter of debate. METHODS AND RESULTS We performed a Bayesian random-effects network meta-analysis of 124 trials (28 240 patients) comparing a total of 10 strategies: saline, statin, N-acetylcysteine (NAC), sodium bicarbonate (NaHCO3), NAC+NaHCO3, ascorbic acid, xanthine, dopaminergic agent, peripheral ischemic preconditioning, and natriuretic peptide. Compared with saline, the risk of CIAKI was reduced by using statin (odds ratio [OR], 0.42; 95% credible interval [CrI], 0.26-0.67), xanthine (OR, 0.32; 95% CrI, 0.17-0.57), ischemic preconditioning (OR, 0.48; 95% CrI, 0.26-0.87), NAC+NaHCO3 (OR, 0.50; 95% CrI, 0.33-0.76), NAC (OR, 0.68; 95% CrI, 0.55-0.84), and NaHCO3 (OR, 0.66; 95% CrI, 0.47-0.90). The benefit of statin therapy was consistent across multiple sensitivity analyses, whereas the efficacy of all the other strategies was questioned by restricting the analysis to high-quality trials. Overall, high heterogeneity was observed for comparisons involving xanthine and ischemic preconditioning, although the impact of NAC and xanthine was probably influenced by publication bias/small-study effect. Hydration alone was the least effective preventive strategy for CIAKI. Meta-regressions did not reveal significant associations with baseline creatinine and contrast volume. In patients with diabetes mellitus, no strategy was found to reduce the incidence of CIAKI. CONCLUSIONS In patients undergoing percutaneous coronary procedures, statin administration is associated with a marked and consistent reduction in the risk of CIAKI compared with saline. Although xanthine, NAC, NaHCO3, NAC+NaHCO3, ischemic preconditioning, and natriuretic peptide may have nephroprotective effects, these results were not consistent across multiple sensitivity analyses.
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Affiliation(s)
- Daniele Giacoppo
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Giuseppe Gargiulo
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Sergio Buccheri
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Patrizia Aruta
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Robert A Byrne
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Salvatore Cassese
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - George Dangas
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Adnan Kastrati
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Roxana Mehran
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Corrado Tamburino
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Davide Capodanno
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.).
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Harada Y, Colleran R, Pinieck S, Giacoppo D, Michel J, Kufner S, Cassese S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Angiographic and clinical outcomes of patients treated with drug-coated balloon angioplasty for in-stent restenosis after coronary bifurcation stenting with a two-stent technique. EUROINTERVENTION 2018; 12:2132-2139. [PMID: 27916742 DOI: 10.4244/eij-d-16-00226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS We conducted this study to evaluate the efficacy of drug-coated balloon therapy for in-stent restenosis after coronary bifurcation stenting. METHODS AND RESULTS Patients who underwent angioplasty with at least one paclitaxel-coated balloon for in-stent restenosis after bifurcation intervention using a two-stent approach were included. Two types of paclitaxel-coated balloon were used, with either an iopromide (iopromide-PCB) or a butyryl tri-n-hexyl citrate (BTHC-PCB) excipient. Angiographic surveillance was planned at six to eight months. Quantitative coronary angiography analysis was carried out with dedicated bifurcation analysis software. Clinical follow-up was performed to one year. In total, 177 patients were included in this study. Information on the type of stent technique used at the time of the index intervention was available for 145 (81.9%) patients: the culotte technique was used in 123 (69.5%) and T-stenting in 22 (12.4%) patients. Iopromide-PCB and BTHC-PCB were used in 124 (70%) and 53 (30%) patients, respectively. Of 125 patients who underwent angiographic follow-up, 30 cases (24%) of binary restenosis were observed. At one year, the composite endpoint of death, myocardial infarction or target lesion revascularisation was observed in 35 patients (24%). There was no significant difference in the incidence of angiographic and clinical outcomes between iopromide-PCB versus BTHC-PCB. CONCLUSIONS In the setting of in-stent restenosis after coronary bifurcation stenting, drug-coated balloons demonstrated good clinical efficacy without the requirement for further stent implantation. There were similar outcomes between iopromide-PCB and BTHC-PCB.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Cassese S, Xhepa E, Ndrepepa G, Kufner S, Colleran R, Giacoppo D, Koppara T, Mankerious N, Byrne RA, Laugwitz KL, Schunkert H, Fusaro M, Kastrati A, Joner M. Vascular response to percutaneous coronary intervention with biodegradable-polymer vs. new-generation durable-polymer drug-eluting stents: a meta-analysis of optical coherence tomography imaging trials. Eur Heart J Cardiovasc Imaging 2018; 19:1294-1301. [DOI: 10.1093/ehjci/jex334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/11/2017] [Indexed: 01/23/2023] Open
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Tobias Koppara
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Nader Mankerious
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Harada Y, Michel J, Lohaus R, Mayer K, Emmer R, Lena Lahmann A, Colleran R, Giacoppo D, Wolk A, Berg JMT, Neumann FJ, Han Y, Adriaenssens T, Tölg R, Seyfarth M, Maeng M, Zrenner B, Jacobshagen C, Wöhrle J, Kufner S, Morath T, Ibrahim T, Bernlochner I, Fischer M, Schunkert H, Laugwitz KL, Mehilli J, A. Byrne R, Kastrati A, Schulz-Schüpke S. Validation of the DAPT score in patients randomized to 6 or 12 months clopidogrel after predominantly second-generation drug-eluting stents. Thromb Haemost 2017; 117:1989-1999. [DOI: 10.1160/th17-02-0101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/21/2017] [Indexed: 11/05/2022]
Abstract
SummaryThe DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups. Primary ischaemic (all-cause death, myocardial infarction, definite stent thrombosis or stroke) and bleeding (TIMI major or minor) outcomes were analyzed in the low and high DAPT score groups. Data of 3976 patients were available for DAPT score calculation. 2407 patients (60.5%) were classified in the low DAPT score group and 1569 patients (39.5%) in the high DAPT score group. In the low DAPT score group there were no significant differences between 6 and 12 months DAPT regarding ischaemic (1.0% vs. 1.4%, HR=0.74, 95% CI, 0.35–1.57; p=0.43) or bleeding outcomes (0.3% vs. 0.8%, HR=0.44, 95% CI, 0.13–1.42; p=0.17). In the high DAPT score group there were also no significant differences between 6 and 12 months DAPT regarding ischaemic (1.9% vs. 1.8%, HR=1.02, 95% CI, 0.49–2.14; p=0.96) or bleeding (0.3% vs. 0.5%, HR=0.51, 95% CI, 0.09–2.78; p=0.44) outcomes. In conclusion, the DAPT score failed to show a differential treatment effect in patients receiving 6 or 12 months DAPT after contemporary drug-eluting stent implantation.
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Colleran R, Byrne R, Rai H, Voll F, Giacoppo D, Cassese S, Joner M, Schunkert H, Kastrati A. TCT-506 An updated meta-analysis of randomized trials comparing complete versus culprit-only revascularization in patients undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.622] [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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Colleran R, Harada Y, Kufner S, Giacoppo D, Joner M, Cassese S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne R. Changes in high-sensitivity troponin after drug-coated balloon angioplasty for drug-eluting stent restenosis. EUROINTERVENTION 2017; 13:962-969. [DOI: 10.4244/eij-d-16-00939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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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Colleran R, Harada Y, Kufner S, Giacoppo D, Joner M, Cassese S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne R. P3303Changes in high-sensitivity troponin after drug-coated balloon angioplasty for drug-eluting stent restenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R. Colleran
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - Y. Harada
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - D. Giacoppo
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T. Ibrahim
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - K.-L. Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R.A. Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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Colleran R, Michel J, Giacoppo D, Cassese S, Joner M, Kastrati A, Byrne R. 2201Comparative efficacy and safety of novel biodegradable polymer sirolimus-eluting stents versus permanent polymer everolimus-eluting stents at 5-year follow-up. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2201] [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: 11/14/2022] Open
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Colleran R, Rheude T, Cassese S, Giacoppo D, Wiebe J, Bohner J, Hoppmann P, Laugwitz KL, Ibrahim T, Kastrati A, Byrne R. P529Angiographic restenosis after coronary stenting in patients with previous coronary bypass surgery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p529] [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: 11/14/2022] Open
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Faggioni M, Baber U, Sartori S, Giustino G, Cohen DJ, Henry TD, Farhan S, Ariti C, Dangas G, Gibson M, Giacoppo D, Krucoff MW, Aquino M, Chandrasekhar J, Moliterno DJ, Colombo A, Vogel B, Chieffo A, Kini AS, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Incidence, Patterns, and Associations Between Dual-Antiplatelet Therapy Cessation and Risk for Adverse Events Among Patients With and Without Diabetes Mellitus Receiving Drug-Eluting Stents. JACC Cardiovasc Interv 2017; 10:645-654. [DOI: 10.1016/j.jcin.2016.12.003] [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: 10/12/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022]
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Affiliation(s)
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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Giacoppo D, Kastrati A. Optimal periprocedural antithrombotic therapy in percutaneous coronary intervention: Between a rock and a hard place? Cardiovasc Revasc Med 2016; 17:491-493. [PMID: 27988082 DOI: 10.1016/j.carrev.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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Harada Y, Michel J, Koenig W, Rheude T, Colleran R, Giacoppo D, Kastrati A, Byrne RA. Prognostic Value of Cardiac Troponin T and Sex in Patients Undergoing Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:JAHA.116.004464. [PMID: 27895042 PMCID: PMC5210430 DOI: 10.1161/jaha.116.004464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) and the influence of sex remain poorly defined. METHODS AND RESULTS Consecutive patients with stable coronary artery disease who underwent elective percutaneous coronary intervention were included. Primary endpoint was all-cause mortality. Unadjusted hazard ratio (HR) in overall and sex-specific population and multivariable adjusted HR were calculated by using Cox proportional hazard models. In a total of 5626 patients, elevated hs-cTnT levels, more than the sex-specific 99th percentile upper reference limit of normal (URL), were observed in 2221 patients (39%) at baseline. During follow-up (median, 14.5 months; 25th-75th percentiles, 6.4-27.2 months), 265 patients died. Mortality was higher in patients with the sex-specific 99th percentile URL compared to those with normal hs-cTnT (17.3% vs 3.4%; HR=6.10; 95% CI, 4.58-8.14; P<0.001). hs-cTnT was an independent predictor of mortality in multivariable adjusted models. The C-statistic was significantly increased by adding hs-cTnT to the basic prediction model for mortality (0.793-0.815; P<0.001). There was a significant interaction between hs-cTnT and sex on mortality. Differences in all-cause mortality between patients with more than the sex-specific 99th percentile URL and those with normal hs-cTnT were numerically larger in male than female patients (male, HR=6.45; 95% CI, 4.68-8.87, P<0.001; female, HR=4.29, 95% CI, 2.36-9.03; P<0.001). CONCLUSIONS In patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, preprocedural hs-cTnT was a strong predictor of mortality in both men and women.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jonathan Michel
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Harada Y, Michel J, Koenig W, Rheude T, Colleran R, Giacoppo D, Wiebe J, Kastrati A, Byrne R. TCT-337 Prognostic value of high-sensitivity cardiac troponin T and gender differences in patients undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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