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Dolmatch B, Cabrera T, Pergola P, Balamuthusamy S, Makris A, Cooper R, Moore E, Licht J, Macaulay E, Maleux G, Pfammatter T, Settlage R, Cristea E, Lansky A. Prospective, randomized, multicenter clinical study comparing a self-expanding covered stent to percutaneous transluminal angioplasty for treatment of upper extremity hemodialysis arteriovenous fistula stenosis. Kidney Int 2023; 104:189-200. [PMID: 36990214 DOI: 10.1016/j.kint.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
Use of a covered stent after percutaneous transluminal angioplasty (PTA) was compared to PTA alone for treatment of upper extremity hemodialysis patients with arteriovenous fistula (AVF) stenoses. Patients with AVF stenosis of 50% or more and evidence of AVF dysfunction underwent treatment with PTA followed by randomization of 142 patients to include a covered stent or 138 patients with PTA alone. Primary outcomes were 30-day safety, powered for noninferiority, and six-month target lesion primary patency (TLPP), powered to test whether TLPP after covered-stent placement was superior to PTA alone. Twelve-month TLPP and six-month access circuit primary patency (ACPP) were also hypothesis tested while additional clinical outcomes were observed through two years. Safety was significantly non-inferior while six- and 12-month TLPP were each superior for the covered stent group compared to PTA alone (six months: 78.7% versus 55.8%; 12 months: 47.9% versus 21.2%, respectively). ACPP was not statistically different between groups at six-months. Observed differences at 24 months favored the covered-stent group: 28.4% better TLPP, fewer target-lesion reinterventions (1.6 ± 1.6 versus 2.8 ± 2.0), and a longer mean time between target-lesion reinterventions (380.4 ± 249.5 versus 217.6 ± 158.4 days). Thus, our multicenter, prospective, randomized study of a covered stent used to treat AVF stenosis demonstrated noninferior safety with better TLPP and fewer target-lesion reinterventions than PTA alone through 24 months.
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Affiliation(s)
- Bart Dolmatch
- Interventional Radiology, Palo Alto Medical Foundation, Mountain View, California, USA; Interventional Radiology, El Camino Hospital, Mountain View, California, USA.
| | | | | | - Saravanan Balamuthusamy
- Tarrant Nephrology Associates, Fort Worth, Texas, USA; Department of Medicine and Nephrology, Texas Christian University School of Medicine, Fort Worth, Texas, USA
| | | | - Randy Cooper
- Southwest Kidney Institute Vascular Center, Tempe, Arizona, USA
| | - Erin Moore
- Cardiothoracic & Vascular Surgical Associates, Jacksonville, Florida, USA; Department of Vascular Surgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Jonah Licht
- Providence Interventional Associates, Providence, Rhode Island, USA; Division of Nephrology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ewan Macaulay
- Department of Vascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Geert Maleux
- Department of Vascular and Interventional Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Thomas Pfammatter
- Department of Diagnostic and Interventional Radiology, University of Zürich Hospital, Zürich, Switzerland
| | - Richard Settlage
- Medical Affairs Department, Becton, Dickinson and Company, Colorado Springs, Colorado, USA
| | - Ecaterina Cristea
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Gitto M, Saito Y, Taoutel R, Schneider MD, Papoutsidakis N, Ardito S, Henry G, Cristea E, Lansky AJ, Altin SE. Angiographic Lesion Discordance in Women Presenting With Ischemic Heart Disease: Comparison of Visual Assessment, Quantitative Coronary Angiography, and Quantitative Flow Ratio. J Invasive Cardiol 2022; 34:E202-E209. [PMID: 35089162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although visual assessment of stenosis severity is routinely used to guide coronary revascularization, there are concerns about its accuracy, especially in women, who present a higher variability in coronary anatomy and ischemic heart disease (IHD). The aim of this study was to assess whether quantitative coronary angiography (QCA) and quantitative flow ratio (QFR) could provide better discrimination of coronary stenosis severity and functional significance than visual assessment alone in women with IHD. METHODS Coronary angiography was performed in a cohort of women with ischemic symptoms and non-invasive stress perfusion imaging. Visual assessment was done by blinded operators in clinical practice, while QCA and QFR were analyzed in an independent core laboratory. RESULTS Ninety-nine consecutive patients with 101 lesions were included in the registry, and QFR was successfully measured in 81 lesions (80.2%). Visual assessment provided higher readings of angiographic severity than QCA in 50.5% (n = 51) of lesions. Mean absolute difference between QCA and visual assessment was significantly higher in lesions with >70% diameter stenosis (DS) (25.3 ± 7.3%), compared with both the 40%-55% (9.3 ± 6.8%; P<.001) and the <40% groups (7.0 ± 6.0%; P<.001). QFR was >0.80 in 33.3% of lesions with visually defined >70% DS, while all lesions with QCA-defined >70% DS had QFR ≤0.80. CONCLUSIONS Interventional cardiologists' visual assessment results in a higher degree of coronary stenosis than QCA. Among women with ischemic symptoms and non-invasive stress perfusion imaging, additional lesion assessment by QCA and QFR may improve operators' ability to determine which patients and lesions will benefit from coronary revascularization.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519 USA.
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Hussain Y, Kereiakes D, Di Mario C, Saito S, Kearney K, Abbott JD, Cristea E, Lansky A. TCT-122 Sex-Specific Characteristics and Outcomes in Coronary Intravascular Lithotripsy: A Patient-Level Analysis of the Disrupt CAD Studies. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gitto M, Taoutel R, Schneider M, Papoutsidakis N, Ardito S, Cristea E, Lansky A, Altin SE. TCT CONNECT-208 Accuracy of Quantitative Coronary Angiography and Visual Assessment for Predicting Functionally Significant Stenoses in Women With Chronic Coronary Syndrome. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.223] [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: 10/23/2022]
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Taoutel R, Gitto M, Saito Y, Schneider M, Ardito S, Papoutsidakis N, Cristea E, Shaddinger D, Lansky A, Altin SE. TCT CONNECT-206 SPECT Stress Testing Versus Contrast-Flow Coronary QFR for Ischemia Detection in Women Presenting With Chronic Coronary Syndromes. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gitto M, Saito Y, Schneider M, Papoutsidakis N, Ardito S, McCarthy M, Cristea E, Lansky A, Altin SE. QUANTITATIVE FLOW RATIO ACCORDING TO THREE-DIMENSIONAL QUANTITATIVE CORONARY ANGIOGRAPHY DEFINED SEVERITY OF STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30804-4] [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: 10/24/2022]
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Gitto M, Saito Y, Schneider M, Papoutsidakis N, Ardito S, McCarthy M, Cristea E, Lansky A, Altin SE. DISCREPANCY BETWEEN VISUALLY ASSESSED AND QUANTITATIVE CORONARY ANGIOGRAPHY DERIVED DIAMETER STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30805-6] [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: 11/25/2022]
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Saito Y, Cristea E, Bouras G, Abizaid A, Lutz M, Carrié D, Weber‐Albers J, Dudek D, Anderson J, Lansky A. Long‐term serial functional evaluation after implantation of the Fantom sirolimus‐eluting bioresorbable coronary scaffold. Catheter Cardiovasc Interv 2020; 97:431-436. [DOI: 10.1002/ccd.28804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/04/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yuichi Saito
- Yale University School of Medicine New Haven Connecticut USA
| | | | - Georgios Bouras
- Yale University School of Medicine New Haven Connecticut USA
| | | | - Matthias Lutz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | | | | | | | | | - Alexandra Lansky
- Yale University School of Medicine New Haven Connecticut USA
- Barts Heart Centre, London and Queen Mary University of London London UK
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Bouras G, Laird J, Zeller T, Holden A, Zhou S, Mena-Hurtado C, Cristea E, Lansky A, Lansky A. TCT-132 Balloon-Expandable ePTFE-Covered Stent for Obstructive Lesions in the Iliac Artery: 24-Month Results from the BOLSTER Trial. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Bouras G, Sullivan T, Zeller T, Nakamura M, Cristea E, Xin Z, Lansky A. TCT-762 The BioMimics 3DTM Stent System in the Femoropopliteal Arteries of Patients with Symptomatic Peripheral Arterial Disease: Clinical and Angiographic Performance in the MIMICS-2 Study. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lansky A, Ng VG, Cristea E, Bouras G, Pietras C, Pangilinan D, Polsonetti B, Herriott D, Barr P, Oppelt T. Abstract 125: Burden & Timing of Recurrent Angina in Patients With Incomplete Revascularization Following Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2016. [DOI: 10.1161/circoutcomes.9.suppl_2.125] [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: 11/16/2022]
Abstract
Background:
Angiographic incomplete revascularization (IR) has been reported in 30-60% of cases following percutaneous coronary intervention (PCI). The extent to which IR contributes to the burden, timing & characteristics of angina & the role of angina in contributing to adverse outcomes has not been defined.
Methods:
A retrospective review of 200 patients with IR after PCI from 9 US cardiology practices was performed to determine the frequency of recurrent angina. All angiograms were reviewed for residual coronary artery disease by an independent core laboratory. IR was defined as residual diameter stenosis >50% by quantitative coronary angiography in any epicardial coronary or major side branch. Recurrent angina was defined as documented worsening of angina or initiation of either ranolazine or long-acting nitrates. Angina was assessed at 30 days, 3 months, 6 months, 9 months, 12 months, & greater than 12 months. We report an interim analysis.
Results:
In the overall population of 200 patients, patients were mostly male (62%) with a mean age of 63.7±13.3 years, & mean BMI of 30.2±6.4. There was a high prevalence of comorbidities including hypertension (93.4%), hyperlipidemia (88.5%), diabetes (52.5%), & prior MI (36.1%). Of the 200 patients, 61 (30%) patients developed recurrent angina at a mean follow-up time of 549 days. Among those with recurrent angina, 26% of patients developed recurrent angina within 30 days of the index PCI procedure. At 3-, 6-, 9, & 12-months, 46%, 62%, 67%, & 80% of patients, respectively, had recurrent angina. The remaining 20% of patients experienced post-PCI angina after 12 months. Baseline demographic factors associated with recurrent angina included hypertension, diabetes, history of angina, prior PCI, & African American ethnicity (See Table 1).
Conclusions:
Angiographically identified IR alone does not adequately identify patients at risk for the development of recurrent angina. Among a cohort of 200 patients with angiographically identified IR, only 30% of patients developed recurrent angina post-PCI. Almost half of patients with recurrent angina experienced it within 3 months of the index PCI procedure. Several common cardiovascular comorbidities including diabetes, hypertension & prior PCI were associated with recurrent angina post-PCI. Complete analysis will be presented.
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Affiliation(s)
| | - Vivian G Ng
- Yale Cardiovascular Rsch Group, New Haven, CT
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Ng VG, Lansky AJ, Toro S, Parise H, Cristea E, Mehran R, Stone GW. Prognostic utility of myocardial blush grade after PCI in patients with NSTE-ACS: Analysis from the ACUITY trial. Catheter Cardiovasc Interv 2015; 88:215-24. [PMID: 25641255 DOI: 10.1002/ccd.25865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/07/2015] [Accepted: 01/25/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated the ability of post-procedural myocardial blush grade (MBG) to stratify outcomes of patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTE-ACS). BACKGROUND MBG strongly correlates with survival after reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI). METHODS Of 13,819 NSTE-ACS patients randomized in the ACUITY trial, 3,115 patients underwent PCI and had MBG analyzed by an independent angiographic core laboratory. We examined net adverse clinical events (NACE; composite ischemia or bleeding), composite ischemia (death, MI or ischemia-driven revascularization) and non-CABG major bleeding according to final MBG. RESULTS At 30 days, patients with MBG-0/1 had higher rates of NACE (25.1% vs. 13.9%, P = 0.002) and composite ischemia (19.1% vs. 9.4%, P = 0.002) than patients with MBG-2/3. At 1-year follow-up, MBG-0/1 patients had significantly higher rates of composite ischemia compared to other patients (27.8% vs. 19.8%, P = 0.02). By multivariable analysis, MBG-0/1 was an independent predictor of 30-day ischemia-driven revascularization (OR 5.74 [2.63, 12.54], P < 0.0001) in the total population and among patients with normal post-PCI epicardial TIMI-3 flow (OR 6.39 [2.06, 19.78], P = 0.001). However, 1-year outcomes were similar between patients with and without normal myocardial perfusion. CONCLUSIONS In conclusion, MBG is a predictor of 30-day revascularization in the overall population and in patients with normal epicardial flow but fails to stratify 1-year outcomes. Thus, unlike in STEMI patients, the prognostic value of MBG in NSTE-ACS patients appears to be limited to the short-term. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Vivian G Ng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut
| | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut
| | - Saleem Toro
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut
| | - Helen Parise
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut
| | - Ecaterina Cristea
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut
| | - Roxana Mehran
- Division of Cardiology, Department of Medicine, Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Division of Cardiology, Department of Medicine, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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Majidi M, Kosinski AS, Al-Khatib SM, Smolders L, Cristea E, Lansky AJ, Stone GW, Mehran R, Gibbons RJ, Crijns HJ, Wellens HJ, Gorgels AP, Krucoff MW. Implications of ventricular arrhythmia “bursts” with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: A biosignature of direct myocellular injury “downstream of downstream”. European Heart Journal: Acute Cardiovascular Care 2014; 4:51-9. [DOI: 10.1177/2048872614532414] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia “bursts” (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR). Methods and results: Anterior STEMI patients with final TIMI 3 flow had protocol-blinded analyses of simultaneous MBG, continuous 12-lead electrocardiogram (ECG) STR, Holter VABs, and day 5–14 SPECT imaging infarct size (IS) assessments. Over 20 million cardiac cycles from >4500 h of continuous ECG monitoring in subjects with STR were obtained. IS and clinical outcomes were examined in patients stratified by MBG and VABs. VABs occurred in 51% (79/154) of subjects. Microcirculation (MBG 2/3) was restored in 75% (115/154) of subjects, of whom 53% (61/115) had VABs. No VABs were observed in subjects without microvascular flow (MBG of 0). Of 115 patients with TIMI 3 flow, STR, and MBG 2/3, those with VABs had significantly larger IS (median: 23.0% vs 6.0%, p=0.001). Multivariable analysis identified reperfusion VABs as a factor significantly associated with larger IS ( p=0.015). Conclusions: Despite restoration of normal epicardial flow, open microcirculation, and STR, concomitant VABs are associated with larger myocardial IS, possibly reflecting myocellular injury in reperfusion settings. Combining angiographic and ECG parameters of epicardial, microvascular, and cellular response to STEMI intervention provides a more predictive “biosignature” of optimal reperfusion than do single surrogate markers.
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Affiliation(s)
- Mohamed Majidi
- Duke Clinical Research Institute, Duke University Medical Center, USA
- Department of Cardiology, Maastricht University Medical Center, The Netherlands
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, USA
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, USA
- Department of Medicine, Duke University Medical Center, USA
| | - Lilian Smolders
- Department of Cardiology, Maastricht University Medical Center, The Netherlands
| | | | | | - Gregg W Stone
- Cardiovascular Research Foundation, USA
- Columbia University, USA
| | - Roxana Mehran
- Cardiovascular Research Foundation, USA
- Mount Sinai Medical Center, USA
| | | | - Harry J Crijns
- Department of Cardiology, Maastricht University Medical Center, The Netherlands
- Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands
| | - Hein J Wellens
- Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands
| | - Anton P Gorgels
- Department of Cardiology, Maastricht University Medical Center, The Netherlands
- Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Duke University Medical Center, USA
- Department of Medicine, Duke University Medical Center, USA
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Parikh P, Kirtane A, Weisz G, Stuckey T, Xu K, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. TWO-YEAR CLINICAL OUTCOMES OF SECOND GENERATION VERSUS FIRST GENERATION CORONARY DRUG-ELUTING STENTS: AN ANALYSIS FROM ADAPT-DES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61899-4] [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: 10/25/2022]
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Kirtane AJ, Sandhu P, Mehran R, McEntegart M, Cristea E, Brener SJ, Xu K, Fahy M, Généreux P, Wessler JD, Stone GW. Association between intraprocedural thrombotic events and adverse outcomes after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (a Harmonizing Outcomes With RevasculariZatiON and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Substudy). Am J Cardiol 2014; 113:36-43. [PMID: 24169019 DOI: 10.1016/j.amjcard.2013.08.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022]
Abstract
The present study sought to determine the extent to which adverse angiographic events encountered during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) are associated with adverse clinical outcomes. Patients with STEMI represent a cohort at particularly high risk of intraprocedural thrombotic events (IPTEs). The overall frequency and implications of IPTEs occurring in patients with STEMI have not been systematically quantified in previous studies. A total of 3,163 patients undergoing primary percutaneous coronary intervention with stent implantation for STEMI in the Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial underwent detailed frame-by-frame core laboratory angiographic analysis to assess IPTEs. The clinical outcomes at 30 days were compared between the patients with and without IPTEs. IPTEs, defined as the development of new or increasing thrombus, abrupt vessel closure, no reflow, slow reflow, and distal embolization at any point during the procedure, occurred in 386 patients (12.2%). The independent predictors of IPTE were thrombus at baseline, lesion length, and randomization to bivalirudin; the patients with IPTEs were also more likely to receive bailout glycoprotein IIb/IIIa inhibitors and unplanned thrombectomy. Compared with patients without IPTEs, the patients with IPTEs had higher 30-day rates of composite major adverse cardiovascular events (death, myocardial infarction, ischemic target vessel revascularization, and stroke; 7.8% vs 4.2%, p = 0.002), major bleeding not related to coronary artery bypass grafting (11.8% vs 6.5%, p <0.001), and all-cause death (4.2% vs 1.8%, p = 0.002). On multivariate analysis, IPTEs were independently associated with 30-day major adverse cardiovascular events, major bleeding, and death. In conclusion, the development of IPTEs in patients undergoing primary percutaneous coronary intervention for STEMI was associated with subsequent adverse outcomes, including major adverse cardiovascular events, major bleeding, and death. Additional studies of strategies to decrease the occurrence of IPTEs are warranted.
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Affiliation(s)
- Ajay J Kirtane
- Department of Medicine, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Prabhdeep Sandhu
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Roxana Mehran
- Cardiovascular Research Foundation, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ecaterina Cristea
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sorin J Brener
- Cardiovascular Research Foundation, New York, New York; Department of Medicine, New York Methodist Hospital, Brooklyn, New York
| | - Ke Xu
- Cardiovascular Research Foundation, New York, New York
| | - Martin Fahy
- Cardiovascular Research Foundation, New York, New York
| | - Philippe Généreux
- Department of Medicine, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Jeffrey D Wessler
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Gregg W Stone
- Department of Medicine, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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Kirtane AJ, Stuckey T, Xu K, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Cristea E, Parise H, Mehran R, Stone G. TCT-152 Is There a Therapeutic Window For Platelet Responsiveness Among PCI Patients? Analysis from the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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De Luca G, Brener SJ, Mehran R, Lansky AJ, McLaurin BT, Cox DA, Cristea E, Fahy M, Stone GW. Implications of pre-procedural TIMI flow in patients with non ST-segment elevation acute coronary syndromes undergoing percutaneous coronary revascularization: Insights from the ACUITY trial. Int J Cardiol 2013; 167:727-32. [DOI: 10.1016/j.ijcard.2012.03.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/04/2012] [Indexed: 11/25/2022]
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Zhao Z, Witzenbichler B, Mintz GS, Jaster M, Choi SY, Wu X, He Y, Margolis MP, Dressler O, Cristea E, Parise H, Mehran R, Stone GW, Maehara A. Dynamic nature of nonculprit coronary artery lesion morphology in STEMI: a serial IVUS analysis from the HORIZONS-AMI trial. JACC Cardiovasc Imaging 2013; 6:86-95. [PMID: 23328566 DOI: 10.1016/j.jcmg.2012.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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] [Received: 02/24/2012] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The authors sought to report the temporal stability of an untreated, nonculprit lesion phenotype in patients presenting with ST-segment elevation myocardial infarction (STEMI). BACKGROUND The temporal stability of the untreated, nonculprit lesion phenotype has been studied using intravascular ultrasound-virtual histology (IVUS) in patients with stable ischemic heart disease, but not in STEMI patients. METHODS As part of a formal substudy of the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, baseline and 13-month follow-up IVUS was performed in 99 untreated nonculprit lesions in 63 STEMI patients. Lesions were classified as pathological intimal thickening (PIT), IVUS-derived thin-cap fibroatheroma (TCFA), thick-cap fibroatheroma (ThCFA), fibrotic plaque, or fibrocalcific plaque. RESULTS The frequency of TCFA increased from 41% at baseline to 54% at follow-up, whereas ThCFAs decreased from 41% to 34% and PIT decreased from 16% to 8%. Among the 41 lesions classified at baseline as TCFA, at follow-up, 32 (78%) were still classified as TCFA, whereas 9 (22%) were classified as ThCFAs or fibrotic plaques. An additional 21 lesions at follow-up were newly classified as TCFA, developing from either PIT or ThCFA. TCFA at baseline that evolved into non-TCFAs trended toward a more distal location than TCFA that did not change (p = 0.12). In lesions classified as TCFA, the minimum lumen area (MLA) decreased from 8.1 (interquartile range [IQR]: 7.4 to 8.8) mm(2) at baseline to 7.8 (IQR: 7.2 to 8.4) mm(2) at follow-up, p < 0.05; this was associated with an increase in percent necrotic core at the MLA site (14% [IQR: 12 to 16] to 19% [IQR: 17 to 22], p < 0.0001) and over the entire length of the lesion (14% [IQR: 12 to 16] to 18% [IQR: 17 to 20], p < 0.0001). CONCLUSIONS Untreated nonculprit lesions in STEMI patients frequently have TCFA morphology that does not change during 13-month follow-up and is accompanied by a decrease in MLA and an increase in necrotic core. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).
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Affiliation(s)
- Zhijing Zhao
- Columbia University Medical Center/The Cardiovascular Research Foundation, New York, New York 10022, USA
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Haude M, Lee SW, Worthley SG, Silber S, Verheye S, Erbs S, Rosli MA, Botelho R, Meredith I, Sim KH, Stella PR, Tan HC, Whitbourn R, Thambar S, Abizaid A, Koh TH, Den Heijer P, Parise H, Cristea E, Maehara A, Mehran R. The REMEDEE Trial. JACC Cardiovasc Interv 2013; 6:334-43. [DOI: 10.1016/j.jcin.2012.10.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022]
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20
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Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink J, Ochala A, Carlton T, Cristea E, Wolf S, Brener S, Chowdhary S, el–omar M, Neunteufl T, Metzger C, Dizon J, Mehran R, Gibson CM. INTRACORONARY ABCIXIMAB AND ASPIRATION THROMBECTOMY DURING PRIMARY PCI FOR ANTERIOR STEMI: ONE–YEAR RESULTS FROM THE RANDOMIZED INFUSE–AMI TRIAL. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61853-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Larsen AI, Nilsen DWT, Yu J, Mehran R, Nikolsky E, Lansky AJ, Caixeta A, Parise H, Fahy M, Cristea E, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Stone GW. Long-term prognosis of patients presenting with ST-segment elevation myocardial infarction with no significant coronary artery disease (from the HORIZONS-AMI trial). Am J Cardiol 2013; 111:643-8. [PMID: 23261001 DOI: 10.1016/j.amjcard.2012.11.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/16/2022]
Abstract
The clinical features and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and no significant coronary artery disease (CAD) have not been well studied. We examined the outcomes of patients with STEMI in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial according to the presence or absence of significant CAD. "No-CAD" was defined by the absence of any lesion with a diameter stenosis of ≥30% on quantitative coronary angiography of the baseline coronary angiogram. Of 3,602 patients, 127 (3.5%) had no-CAD. Of these, 86 (67.7%) had angiographically normal coronary arteries, and 41 (32.3%) had mild disease (diameter stenosis <30%). Eight patients had previously been treated with coronary artery bypass grafting. Compared to patients with CAD, patients with no-CAD were younger, had a lower body mass index, were more frequently black, had a lower prevalence of smoking and previous angina, and had a greater left ventricular ejection fraction. Cardiac enzymes were elevated in fewer patients with no-CAD than in those with CAD (63.2% vs 98.7%, p <0.001). At 3 years of follow-up, the patients with no-CAD versus CAD had lower rates of major adverse cardiovascular events (7.7% vs 22.2%, p = 0.002), net adverse clinical events (major adverse cardiovascular events or major bleeding not related to coronary artery bypass grafting, 12.5% vs 26.9%, p = 0.005), and postprocedure coronary revascularization (0% vs 19.5%, p <0.001). The differences in the rates of death or reinfarction, stroke, and major bleeding were not statistically significant. In conclusion, 3.5% of patients with STEMI had no significant CAD. The 3-year prognosis for these patients was favorable compared to that of patients with STEMI and with obstructive CAD.
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Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Rinaldi MJ, Kirtane A, Xu K, Witzenbichler B, Weisz G, Neumann F, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Stuckey T, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. IMPACT OF POINT–OF–CARE PLATELET FUNCTION TESTING AMONG PATIENTS WITH AND WITHOUT ACUTE CORONARY SYNDROMES UNDERGOING PCI WITH DRUG–ELUTING STENTS: AN ADAPT–DES SUBSTUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61857-4] [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: 11/25/2022]
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23
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Stuckey TD, Kirtane A, Xu K, Witzenbichler B, Weisz G, Rinaldi M, Neumann F, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. LACK OF ASSOCIATION BETWEEN ON–TREATMENT PLATELET REACTIVITY AND ISCHEMIC OUTCOMES IN DIABETIC PATIENTS: ONE YEAR RESULTS OF THE ADAPT–DES STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61737-4] [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: 10/27/2022]
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24
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Brener SJ, Cristea E, Kirtane AJ, McEntegart MB, Xu K, Mehran R, Stone GW. Intra-Procedural Stent Thrombosis. JACC Cardiovasc Interv 2013; 6:36-43. [DOI: 10.1016/j.jcin.2012.08.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/27/2012] [Accepted: 08/16/2012] [Indexed: 11/30/2022]
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25
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Ruiz-García J, Lerman A, Weisz G, Maehara A, Mintz GS, Fahy M, Xu K, Lansky AJ, Cristea E, Farah TG, Teles R, Botker HE, Templin B, Zhang Z, de Bruyne B, Serruys PW, Stone GW. Age- and gender-related changes in plaque composition in patients with acute coronary syndrome: the PROSPECT study. EUROINTERVENTION 2012; 8:929-38. [DOI: 10.4244/eijv8i8a142] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [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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26
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Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, Mehran R, Della Riva D, Fahy M, Xu K, Stone GW. A New Score for Risk Stratification of Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2012; 5:1108-16. [DOI: 10.1016/j.jcin.2012.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
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27
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Brener SJ, Weisz G, Maehara A, Mehran R, McPherson J, Farhat N, Marso SP, Fahy M, Xu K, Cristea E, Mintz GS, De Bruyne B, Serruys P, Stone GW. Does clinical presentation affect outcome among patients with acute coronary syndromes undergoing percutaneous coronary intervention? Insights from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study. Am Heart J 2012; 164:561-7. [PMID: 23067915 DOI: 10.1016/j.ahj.2012.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND In some prior studies, patients with ST-elevation myocardial infarction (STEMI) as compared with patients with non-STEMI (NSTEMI) tended to have a higher early mortality but similar long-term outcomes. We compared the angiographic and intravascular ultrasound (IVUS) characteristics of patients with STEMI and NSTEMI in the PROSPECT study to evaluate the independent prognostic value of clinical presentation on long-term outcome. METHODS After successful revascularization, patients had 3-vessel quantitative coronary angiography, gray scale, and radiofrequency intravascular ultrasound (IVUS) imaging. The primary end point was the occurrence of major adverse cardiac events (MACE) (cardiac death, myocardial infarction, or rehospitalization for unstable or progressive angina). RESULTS There were 211 patients (31.6%) with STEMI and 457 (68.4%) with NSTEMI. Patients with STEMI and NSTEMI had similar angiographic and IVUS morphologic characteristics. At 3 years, MACE occurred in 22.1% and 19.6%, respectively (hazard ratio [HR] 1.16 [0.81, 1.68], P = .42). There was a higher overall mortality (HR 2.16 [0.94, 4.99], P = .06) and a significantly higher incidence of probable stent thrombosis (HR 4.34 [1.09, 17.36], P = .02) in the STEMI cohort. There were no significant differences between the 2 groups with respect to events related to culprit or to nonculprit lesions. ST-elevation myocardial infarction presentation was not an independent predictor of 3-year MACE (HR 1.14 [0.77, 1.67], P = .52). CONCLUSION Patients with STEMI and NSTEMI did not differ with respect to residual nonculprit lesion angiographic or IVUS characteristics and had similar rates of MACE at 3 years, without late "catch-up" in NSTEMI. However, probable stent thrombosis and mortality were higher in the STEMI cohort.
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Brener SJ, Cristea E, Lansky AJ, Fahy M, Mehran R, Stone GW. Operator versus core laboratory assessment of angiographic reperfusion markers in patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv 2012; 5:563-9. [PMID: 22828707 DOI: 10.1161/circinterventions.112.969022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush Grade (MBG) are important prognostic indicators before and after primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction; however, the concordance and relative prognostic utility of operator (Op) versus angiography core laboratory (ACL) assessed TIMI flow and MBG are unknown. METHODS AND RESULTS Baseline and final Op and ACL TIMI flow and MBG assessment were compared from the Harmonizing Outcomes with RevascularIZatiON and Stents in AMI trial in 3345 patients undergoing primary PCI using Cohen's κ coefficient. κ Was highest for pre-PCI TIMI flow (0.51, representing moderate agreement) and lowest for post-PCI MBG (0.20, representing fair agreement). Discordance between Op and ACL for final TIMI flow (0 to 2 versus 3) occurred in 12.9% of patients and for final MBG (0 to 1 versus 2 to 3) in 22.4%. Among 415 patients with final TIMI flow 0 to 2 by ACL, Op scoring was TIMI flow 3 in 267 (64.3%). Similarly, among 706 patients with final MBG 0 to 1 by ACL, 563 (79.7%) were classified as MBG 2 to 3 by Op. Post-PCI TIMI 3 flow and MBG 2 to 3 strongly correlated with 3-year survival, as assessed by both Op and ACL (P<0.0001). Mortality was intermediate in patients in whom ACL and Op were discordant, without marked prognostic differences between the discordant groups. CONCLUSIONS Op and ACL assessment of angiographic markers of reperfusion in ST-segment-elevation myocardial infarction demonstrates fair to moderate agreement. Op tended to favorably grade unfavorable ACL results. Nonetheless, both Op and ACL assessment of reperfusion strongly inform prediction of 3-year mortality.
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Affiliation(s)
- Sorin J Brener
- Cardiac Catheterization Laboratory, New York Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA.
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Rosner GF, Kirtane AJ, Genereux P, Lansky AJ, Cristea E, Gersh BJ, Weisz G, Parise H, Fahy M, Mehran R, Stone GW. Impact of the Presence and Extent of Incomplete Angiographic Revascularization After Percutaneous Coronary Intervention in Acute Coronary Syndromes. Circulation 2012; 125:2613-20. [DOI: 10.1161/circulationaha.111.069237] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [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: 11/16/2022]
Abstract
Background—
The clinical significance of incomplete coronary revascularization (ICR) after percutaneous coronary intervention in patients with acute coronary syndromes is unknown.
Methods and Results—
We performed quantitative angiography of the entire coronary tree in 2954 patients with acute coronary syndromes in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. ICR was variably defined if any lesion with diameter stenosis (DS) cutoffs ranging from ≥30% to ≥70% with reference vessel diameter ≥2.0 mm remained after percutaneous coronary intervention. The primary outcome was 1-year composite rate of major adverse cardiac events (death, myocardial infarction, or ischemia-driven unplanned revascularization). With the use of DS cutoffs ≥30%, ≥40%, ≥50%, ≥60%, and ≥70%, the prevalence of ICR after percutaneous coronary intervention was 75%, 55%, 37%, 25%, and 17%, respectively. The 1-year major adverse cardiac event rate was increased among patients with ICR using all of the DS cutoffs. ICR (≥50% DS) was associated with higher 1-year rates of myocardial infarction (12.0% versus 8.2%; hazard ratio, 1.50; 95% confidence interval, 1.18–1.89;
P
=0.0007) and ischemia-driven unplanned revascularization (15.7% versus 10.2%; hazard ratio, 1.58; 95% confidence interval, 1.28–1.96;
P
<0.0001), with a trend toward increased mortality (3.1% versus 2.2%; hazard ratio, 1.43; 95% confidence interval, 0.90–2.27;
P
=0.13). By multivariable analysis, ICR (≥50% DS) was an independent predictor of 1-year major adverse cardiac events (hazard ratio, 1.36; 95% confidence interval, 1.12–1.64;
P
=0.002). The impact of ICR on major adverse cardiac events was similar regardless of chronic total occlusion presence, but it was more pronounced with a greater number of nonrevascularized lesions.
Conclusions—
Depending on the threshold of percent DS, ICR was present in 17% to 75% of patients with acute coronary syndromes after percutaneous coronary intervention. Regardless of the threshold, ICR was strongly associated with 1-year myocardial infarction, ischemia-driven unplanned revascularization, and major adverse cardiac events.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00093158.
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Affiliation(s)
- Gregg F. Rosner
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Ajay J. Kirtane
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Philippe Genereux
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Alexandra J. Lansky
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Ecaterina Cristea
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Bernard J. Gersh
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Giora Weisz
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Helen Parise
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Martin Fahy
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Roxana Mehran
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
| | - Gregg W. Stone
- From the New York–Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (G.F.R., A.J.K., P.G., A.J.L., E.C., G.W., H.P., M.F., R.M., G.W.S.), and Mayo Clinic, Rochester, MN (B.J.G.)
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Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JHE, Ochala A, Carlton TW, Cristea E, Wolff SD, Brener SJ, Chowdhary S, El-Omar M, Neunteufl T, Metzger DC, Karwoski T, Dizon JM, Mehran R, Gibson CM. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA 2012; 307:1817-26. [PMID: 22447888 DOI: 10.1001/jama.2012.421] [Citation(s) in RCA: 385] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Thrombus embolization during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI are bolus intracoronary abciximab and manual aspiration thrombectomy. OBJECTIVE To determine whether bolus intracoronary abciximab, manual aspiration thrombectomy, or both reduce infarct size in high-risk patients with STEMI. DESIGN, SETTING, AND PATIENTS Between November 28, 2009, and December 2, 2011, 452 patients presenting at 37 sites in 6 countries within 4 hours of STEMI due to proximal or mid left anterior descending artery occlusion undergoing primary PCI with bivalirudin anticoagulation were randomized in an open-label, 2 x 2 factorial design to bolus intracoronary abciximab delivered locally at the infarct lesion site vs no abciximab and to manual aspiration thrombectomy vs no thrombectomy. INTERVENTIONS A 0.25-mg/kg bolus of abciximab was administered at the site of the infarct lesion via a local drug delivery catheter. Manual aspiration thrombectomy was performed with a 6 F aspiration catheter. MAIN OUTCOME MEASURES Primary end point: infarct size (percentage of total left ventricular mass) at 30 days assessed by cardiac magnetic resonance imaging (cMRI) in the abciximab vs no abciximab groups (pooled across the aspiration randomization); major secondary end point: 30-day infarct size in the aspiration vs no aspiration groups (pooled across the abciximab randomization). RESULTS Evaluable cMRI results at 30 days were present in 181 and 172 patients randomized to intracoronary abciximab vs no abciximab, respectively, and in 174 and 179 patients randomized to manual aspiration vs no aspiration, respectively. Patients randomized to intracoronary abciximab compared with no abciximab had a significant reduction in 30-day infarct size (median, 15.1%; interquartile range [IQR], 6.8%-22.7%; n = 181, vs 17.9% [IQR, 10.3%-25.4%]; n = 172; P = .03). Patients randomized to intracoronary abciximab also had a significant reduction in absolute infarct mass (median, 18.7 g [IQR, 7.4-31.3 g]; n = 184, vs 24.0 g [IQR, 12.1-34.2 g]; n = 175; P = .03) but not abnormal wall motion score (median, 7.0 [IQR, 2.0-10.0]; n = 188, vs 8.0 [IQR, 3.0-10.0]; n = 184; P = .08). Patients randomized to aspiration thrombectomy vs no aspiration had no significant difference in infarct size at 30 days (median, 17.0% [IQR, 9.0%-22.8%]; n = 174, vs 17.3% [IQR, 7.1%-25.5%]; n = 179; P = .51), absolute infarct mass (median, 20.3 g [IQR, 9.7-31.7 g]; n = 178, vs 21.0 g [IQR, 9.1-34.1 g]; n = 181; P = .36), or abnormal wall motion score (median, 7.5 [IQR, 2.0-10.0]; n = 186, vs 7.5 [IQR, 2.0-10.0]; n = 186; P = .89). CONCLUSION In patients with large anterior STEMI presenting early after symptom onset and undergoing primary PCI with bivalirudin anticoagulation, infarct size at 30 days was significantly reduced by bolus intracoronary abciximab delivered to the infarct lesion site but not by manual aspiration thrombectomy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00976521.
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Affiliation(s)
- Gregg W Stone
- Columbia University Medical Center and New York–Presbyterian Hospital, New York, New York 10022, USA.
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McEntegart MB, Kirtane AJ, Cristea E, Brener S, Mehran R, Fahy M, Moses JW, Stone GW. Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Are Associated With Adverse Outcomes. J Am Coll Cardiol 2012; 59:1745-51. [DOI: 10.1016/j.jacc.2012.02.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/19/2012] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
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Brener SJ, Mehran R, Dressler O, Cristea E, Stone GW. Diabetes mellitus, myocardial reperfusion, and outcome in patients with acute ST-elevation myocardial infarction treated with primary angioplasty (from HORIZONS AMI). Am J Cardiol 2012; 109:1111-6. [PMID: 22244381 DOI: 10.1016/j.amjcard.2011.11.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/27/2022]
Abstract
Diabetes mellitus (DM) increases mortality in acute ST-segment elevation myocardial infarction (STEMI) but the responsible mechanism is not fully elucidated. We compared the rate of successful myocardial reperfusion measured by tissue myocardial perfusion grade (TMPG) and outcomes in patients with and without DM undergoing primary percutaneous coronary intervention (PCI) for STEMI. Patients enrolled in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS AMI) trial were analyzed according to presence of DM with respect to TMPG after PCI and outcomes at 30 days and 3 years. Multivariable logistic regression was performed to identify the independent contribution to mortality of DM and TMPG and the interaction between the 2 was assessed. Complete data were available for 3,265 patients, of whom 533 (16.3%) had DM. Diabetic patients were significantly older and heavier and had more risk factors for coronary disease and more previous MI, revascularization, and heart failure. There were no differences in rates of Thrombolysis In Myocardial Infarction grade 3 flow after PCI in the infarct artery or TMPG 2/3 between patients with and without DM. Compared to nondiabetics, mortality was significantly higher at 30 days and at 3 years in the DM group (1.8% vs 4.5%, p = 0.0002 and 5.4% vs 11.0%, p <0.0001, respectively). DM and TMPG were significantly associated with 3-year mortality, but there was no statistical interaction between DM and TMPG (p = 0.70). In conclusion, DM is associated with a significantly higher risk of death but this association is not mediated by impaired epicardial or myocardial reperfusion.
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Claessen BE, Smits PC, Kereiakes DJ, Parise H, Fahy M, Kedhi E, Serruys PW, Lansky AJ, Cristea E, Sudhir K, Sood P, Simonton CA, Stone GW. Impact of lesion length and vessel size on clinical outcomes after percutaneous coronary intervention with everolimus- versus paclitaxel-eluting stents pooled analysis from the SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) and COMPARE (Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) Randomized Trials. JACC Cardiovasc Interv 2012; 4:1209-15. [PMID: 22115661 DOI: 10.1016/j.jcin.2011.07.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [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: 03/24/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of reference vessel diameter (RVD) and lesion length (LL) on the relative safety and efficacy of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES). BACKGROUND Lesion length and RVD are well-known predictors of adverse events after percutaneous coronary intervention. METHODS Patient-level data were pooled from the randomized SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) II, III, IV and COMPARE (Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) trials. Quantitative angiographic core laboratory data were available for 6,183 patients randomized to EES (n = 3,944) or PES (n = 2,239). Long lesions and small vessels were defined as LL >median (13.4 mm) and RVD ≤median (2.65 mm), respectively. Major adverse cardiac events (MACE) (consisting of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed at 2 years, according to stent type in 3 groups: short lesions in large vessels (group A, n = 1,297); long lesions or small vessels but not both (group B, n = 2,981); and long lesions in small vessels (group C, n = 1,905). RESULTS The pooled 2-year MACE rates were 5.6%, 8.2%, and 10.4% in Groups A, B, and C, respectively (p < 0.0001). There was no significant interaction between lesion group and stent type (p = 0.64), indicating lower MACE with EES compared with PES regardless of LL and RVD. However, the absolute difference was largest in Groups B and C. In Group A, 2-year MACE rates were not significantly different between EES and PES (4.8% vs. 7.0%, respectively, p = 0.11). In contrast, EES was associated with lower 2-year rates of MACE in Group B (6.6% vs. 11.2%, p < 0.01) and in Group C (9.1% vs. 12.7%, p = 0.008) as well as lower rates of myocardial infarction, target lesion revascularization, and stent thrombosis. Multivariable analysis confirmed EES versus PES as an independent predictor of freedom from MACE in Groups B and C. CONCLUSIONS Patients with short lesions in large vessels have low rates of MACE at 2 years after treatment with either EES or PES. In higher-risk patients with long lesions and/or small vessels, EES results in significant improvements in both clinical safety and efficacy outcomes. (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions; NCT00180310; SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00180479; SPIRIT IV Clinical Trial: Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00307047; A Randomized Controlled Trial of Everolimus-eluting Stents and Paclitaxel-eluting Stents for Coronary Revascularization in Daily Practice: The COMPARE Trial; NCT01016041).
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Affiliation(s)
- Bimmer E Claessen
- New York Presbyterian Hospital, Columbia University, New York, NY, USA
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Kirtane AJ, Parise H, Witzenbichler B, Weisz G, Rinaldi M, Neumann FJ, Metzger D, Henry T, Cox D, Duffy P, Brodie B, Stuckey T, Mazzaferri E, Cristea E, Mehran R, Stone G. DOES PLATELET FUNCTION TESTING ADD SIGNIFICANT INCREMENTAL RISK STRATIFICATION TO UNSELECTED PATIENTS UNDERGOING DES IMPLANTATION? THE ADAPT-DES STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60293-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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Brener SJ, Mintz G, Cristea E, Weisz G, Maehara A, McPherson J, Marso S, Farhat N, Botker HE, Dressler O, Xu K, Templin B, Zhang Z, Lansky A, de Bruyne B, Serruys P, Stone G. CHARACTERISTICS AND CLINICAL SIGNIFICANCE OF ANGIOGRAPHICALLY MILD LESIONS IN ACUTE CORONARY SYNDROMES: INSIGHTS FROM THE PROSPECT STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60353-2] [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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Yakushiji T, Inaba S, Maehara A, Cristea E, Brener S, Witzenbichler B, Guagliumi G, Xu K, Mehran R, Stone G, Mintz G. FREQUENCY, MECHANISMS AND IMPLICATIONS OF LATE PERI-STENT CONTRAST STAINING: ANALYSIS FROM THE HORIZONS-AMI TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60171-5] [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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Kirtane AJ, Rinaldi M, Parise H, Witzenbichler B, Weisz G, Neumann FJ, Metzger D, Henry T, Cox D, Duffy P, Brodie B, Stuckey T, Mazzaferri E, Cristea E, Mehran R, Stone G. IMPACT OF POINT-OF-CARE PLATELET FUNCTION TESTING AMONG PATIENTS WITH AND WITHOUT ACUTE CORONARY SYNDROMES UNDERGOING PCI WITH DRUG-ELUTING STENTS: AN ADAPT-DES SUBSTUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brener SJ, Mehran R, Dressler O, Cristea E, Stone G. DIABETES MELLITUS, MYOCARDIAL REPERFUSION AND OUTCOME IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY ANGIOPLASTY; INSIGHTS FROM HORIZONS AMI. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60464-1] [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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Sanidas EA, Mintz GS, Maehara A, Cristea E, Wennerblom B, Iñiguez A, Fajadet J, Fahy M, Dressler O, Weisz G, Templin B, Zhang Z, Lansky AJ, de Bruyne B, Serruys P, Stone GW. Adverse Cardiovascular Events Arising From Atherosclerotic Lesions With and Without Angiographic Disease Progression. JACC Cardiovasc Imaging 2012; 5:S95-S105. [DOI: 10.1016/j.jcmg.2011.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/06/2011] [Accepted: 08/18/2011] [Indexed: 10/28/2022]
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Brener SJ, Mintz GS, Cristea E, Weisz G, Maehara A, McPherson JA, Marso SP, Farhat N, Botker HE, Dressler O, Xu K, Templin B, Zhang Z, Lansky AJ, de Bruyne B, Serruys PW, Stone GW. Characteristics and Clinical Significance of Angiographically Mild Lesions in Acute Coronary Syndromes. JACC Cardiovasc Imaging 2012; 5:S86-94. [DOI: 10.1016/j.jcmg.2011.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 11/25/2022]
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Kirtane AJ, Stuckey T, Parise H, Witzenbichler B, Weisz G, Rinaldi M, Neumann FJ, Metzger D, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Cristea E, Mehran R, Stone G. IMPACT OF POINT-OF-CARE PLATELET FUNCTION TESTING AMONG DIABETIC AND NON-DIABETIC PATIENTS UNDERGOING PCI WITH DRUG-ELUTING STENTS: AN ADAPT-DES SUBSTUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maehara A, Cristea E, Mintz GS, Lansky AJ, Dressler O, Biro S, Templin B, Virmani R, de Bruyne B, Serruys PW, Stone GW. Definitions and Methodology for the Grayscale and Radiofrequency Intravascular Ultrasound and Coronary Angiographic Analyses. JACC Cardiovasc Imaging 2012; 5:S1-9. [DOI: 10.1016/j.jcmg.2011.11.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 10/28/2022]
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Palmerini T, Caixeta A, Genereux P, Cristea E, Lansky A, Mehran R, Dangas G, Lazar D, Sanchez R, Fahy M, Xu K, Stone GW. Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. Am Heart J 2012; 163:383-91, 391.e1-5. [PMID: 22424008 DOI: 10.1016/j.ahj.2011.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/07/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. METHODS The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. RESULTS Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. CONCLUSIONS In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.
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McPherson JA, Maehara A, Weisz G, Mintz GS, Cristea E, Mehran R, Foster M, Verheye S, Rabbani L, Xu K, Fahy M, Templin B, Zhang Z, Lansky AJ, de Bruyne B, Serruys PW, Stone GW. Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention. JACC Cardiovasc Imaging 2012; 5:S76-85. [DOI: 10.1016/j.jcmg.2012.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
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Rosner G, Kirtane A, Genereux P, Lansky A, Cristea E, Gersh B, Weisz G, Parise H, Mehran R, Stone G. IMPACT OF INCOMPLETE CORONARY REVASCULARIZATION ON ONE-YEAR OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROMES: THE ACUITY TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Choi SY, Maehara A, Cristea E, Witzenbichler B, Guagliumi G, Brodie B, Kellett MA, Dressler O, Lansky AJ, Parise H, Mehran R, Mintz GS, Stone GW. Usefulness of minimum stent cross sectional area as a predictor of angiographic restenosis after primary percutaneous coronary intervention in acute myocardial infarction (from the HORIZONS-AMI Trial IVUS substudy). Am J Cardiol 2012; 109:455-60. [PMID: 22118823 DOI: 10.1016/j.amjcard.2011.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 10/07/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022]
Abstract
HORIZONS-AMI was a prospective dual-arm randomized trial of different antithrombotic regimens and stent types in patients with ST-segment elevation myocardial infarction. A formal intravascular ultrasound (IVUS) substudy enrolled 464 patients with baseline and 13-month follow-up at 36 centers. Of them, 318 patients with 355 lesions were evaluated for this study. Angiographic restenosis occurred in 45 of 355 lesions (12.7%). Bare-metal stent use (45.5% vs 21.2%, p <0.001) and diabetes mellitus (29.5% vs 10.9%, p <0.001) were more prevalent in patients with versus without restenosis. Postprocedure IVUS minimum lumen area (5.6 mm(2), 5.0 to 6.1, vs 6.7 mm(2), 6.5 to 6.9, p <0.001), minimum stent area (5.7 mm(2), 5.1 to 6.3, vs 6.9 mm(2), 6.6 to 7.1, p <0.001), and reference average lumen area (7.7 mm(2), 6.8 to 8.6, vs 9.7 mm(2), 9.3 to 10.1, p <0.001) were smaller in restenotic versus nonrestenotic lesions. By multivariable analysis, minimum stent area was an independent predictor of angiographic restenosis (odds ratio 0.75, 95% confidence interval 0.61 to 0.93, p = 0.009) in addition to diabetes, bare-metal stent use, and longer stent length. Attenuated plaque behind the stent struts had a trend to predict less binary restenosis (p = 0.07). In conclusion, a smaller IVUS minimum stent area was an independent predictor of angiographic restenosis after primary percutaneous intervention in patients with ST-segment elevation myocardial infarction, similar to patients with stable coronary artery disease.
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Affiliation(s)
- So-Yeon Choi
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA
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Laird JR, Katzen BT, Scheinert D, Lammer J, Carpenter J, Buchbinder M, Dave R, Ansel G, Lansky A, Cristea E, Collins TJ, Goldstein J, Cao AY, Jaff MR. Nitinol Stent Implantation vs. Balloon Angioplasty for Lesions in the Superficial Femoral and Proximal Popliteal Arteries of Patients With Claudication: Three-Year Follow-up From the RESILIENT Randomized Trial. J Endovasc Ther 2012; 19:1-9. [DOI: 10.1583/11-3627.1] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Wöhrle J, Merkle N, Kunze M, Cristea E, Mehran R, Rottbauer W, Stone GW. Effect of bivalirudin compared with unfractionated heparin plus abciximab on infarct size and myocardial recovery after primary percutaneous coronary intervention: the horizons-AMI CMRI substudy. Catheter Cardiovasc Interv 2011; 79:1083-9. [PMID: 22162175 DOI: 10.1002/ccd.23179] [Citation(s) in RCA: 22] [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] [Received: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Myocardial infarct size is a strong independent predictor of mortality in patients with ST-elevation myocardial infarction (STEMI). In the Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor reduced cardiac mortality in STEMI patients, which was attributed to reduced major bleeding. Whether a possible reduction in infarct size with bivalirudin may have contributed to the enhanced survival with this agent is unknown. METHODS Cardiac magnetic resonance imaging was performed within 7 days and after 6 months in 51 randomized patients from a single center in HORIZONS-AMI trial (N = 28 bivalirudin, N = 23 heparin plus abciximab). Infarct size, microvascular obstruction (MVO), left ventricular ejection fraction (LVEF), and LV end-diastolic and end-systolic volume indices were evaluated. RESULTS Infarct size was not significantly different after treatment with bivalirudin compared with heparin plus abciximab either within 7 days (median 9.3% [interquartile range 4.9%, 26.6%] vs. 20.0% [5.9%, 28.2%], P = 0.28) or at 6 months 6.7% [3.8%, 20.0%] vs. 8.2% [1.8%, 16.5%], P = 0.73). MVO was present in 28.6% versus 34.8% of patients respectively (P = 0.63). LVEF and LV volume indices also did not significantly differ between the two groups at either time period, nor were differences in myocardial recovery evident. CONCLUSIONS In conclusion, in the HORIZONS-AMI Cardiac magnetic resonance imaging (CMRI) substudy, cardiac magnetic resonance imaging within 7 days and at 6 months after primary percutaneous coronary intervention (PCI) did not demonstrate significant differences in infarct size, MVO, LVEF, or LV volume indices in patients treated with bivalirudin compared with unfractionated heparin plus abciximab.
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Affiliation(s)
- Jochen Wöhrle
- Clinic of Internal Medicine II, University of Ulm, Ulm, Germany.
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Palmerini T, Dangas G, Mehran R, Caixeta A, Généreux P, Fahy MP, Xu K, Cristea E, Lansky AJ, Stone GW. Predictors and Implications of Stent Thrombosis in Non–ST-Segment Elevation Acute Coronary Syndromes. Circ Cardiovasc Interv 2011; 4:577-84. [DOI: 10.1161/circinterventions.111.963884] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 11/16/2022]
Affiliation(s)
- Tullio Palmerini
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - George Dangas
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Roxana Mehran
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Adriano Caixeta
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Philippe Généreux
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Martin P. Fahy
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Ke Xu
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Ecaterina Cristea
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Alexandra J. Lansky
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
| | - Gregg W. Stone
- From Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy (T.P.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (T.P., A.C., P.G., M.F., K.X., E.C., G.W.S.); Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, NY (G.D., R.M.); and Yale University School of Medicine, New Haven, CT (A.L.)
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Généreux P, Palmerini T, Caixeta A, Cristea E, Mehran R, Sanchez R, Lazar D, Jankovic I, Corral MD, Dressler O, Fahy MP, Parise H, Lansky AJ, Stone GW. SYNTAX Score Reproducibility and Variability Between Interventional Cardiologists, Core Laboratory Technicians, and Quantitative Coronary Measurements. Circ Cardiovasc Interv 2011; 4:553-61. [DOI: 10.1161/circinterventions.111.961862] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [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: 11/16/2022]
Affiliation(s)
- Philippe Généreux
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Tullio Palmerini
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Adriano Caixeta
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Ecaterina Cristea
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Roxana Mehran
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Raquel Sanchez
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Dana Lazar
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Ivana Jankovic
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Maria D. Corral
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Ovidiu Dressler
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Martin P. Fahy
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Helen Parise
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Alexandra J. Lansky
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
| | - Gregg W. Stone
- From Columbia University Medical Center and the Cardiovascular Research Foundation; New York, NY
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