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Shinzato MH, Santos N, Nishida G, Moriya H, Assef J, Feres F, Hortegal RA. Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy. Cardiovasc Ultrasound 2024; 22:4. [PMID: 38433236 PMCID: PMC10910762 DOI: 10.1186/s12947-024-00323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. MAIN BODY This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. CONCLUSION GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF.
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Affiliation(s)
- Mariane Higa Shinzato
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Natasha Santos
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Gustavo Nishida
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Henrique Moriya
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
- Biomedical Engineering Laboratory, University of Sao Paulo, São Paulo, Brazil
| | - Jorge Assef
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Fausto Feres
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Renato A Hortegal
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909.
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Júnior RR, Nigro C, Braga SN, Sousa AG, Feres F, Costa JDR. Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: A prospective randomized clinical trial. J Invasive Cardiol 2023; 35. [PMID: 38108873 DOI: 10.25270/jic/23.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Markers of myocardial injury, such as creatine kinase-myocardial band (CK-MB) mass, are elevated in up to 30% of patients undergoing percutaneous coronary intervention (PCI) with stent deployment. This elevation represents myocardial injury that can impact the patient in the long term, including the risk of death. Sevoflurane, an inhaled anesthetic, may have cardioprotective properties that benefit patients undergoing PCI. The primary objective was to compare serum CK-MB mass raise in patients who received sevoflurane to those who received a placebo prior to PCI. METHODS We enrolled patients with coronary artery disease who were eligible for PCI in a randomized (1:1), double-blind, placebo-controlled trial; patients having experienced acute myocardial infarction within 72 hours and those with saphenous vein graft stenting were excluded. Patients (n = 1254) were randomized to receive sevoflurane (2% inspired fraction) or placebo (oxygen alone) for 30 minutes prior to PCI. Additionally, we compared substantial elevations in CK-MB mass (defined as >5x the upper limit of normal), length of stay in the intensive care unit and in-hospital, and 1-year mortality. RESULTS Sevoflurane was unable to promote cardioprotection, as determined by CK-MB mass levels (sevoflurane group: 2.52 ± 9.64; control group: 1.84 ± 8.58; P=.32). No effect was noticed on the reduction among patients who (AQ: with?) increase (AQ: increased?) marker levels (prevalence of increase in CK-MB mass greater than the upper limit of normality was 30.8% in the sevoflurane group and 28.9% in the control group; P=.33; 4.6% vs 3.1%, respectively, for increases 5x above the upper limit of normality [P=.21]). CONCLUSIONS Sevoflurane failed to reduce myocardial injury after PCI. Therefore, its usage should not be routinely recommended.
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Affiliation(s)
- Ronaldo Rossi Júnior
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Caetano Nigro
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | | | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Jose de Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Hospital Sâo Domingos, Rede DASA, São Luis, Brazil.
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Meniconi MA, Oliveira FJC, Cervone AC, Togna DJD, Feres F, Ramos AIDO, Siqueira DADA. Viability and Safety of Early Hospital Discharge after Minimalist TAVI in the Brazilian Unified Health System. Arq Bras Cardiol 2023; 120:e20230328. [PMID: 37878895 PMCID: PMC10547432 DOI: 10.36660/abc.20230328] [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: 05/12/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 10/27/2023] Open
Abstract
Central Illustration : Viability and Safety of Early Hospital Discharge after Minimalist TAVI in the Brazilian Unified Health System Results after transcatheter aortic valve implantation with a minimalist approach. CKD: chronic kidney disease; PO: postoperative days; TAVI: transcatheter aortic valve implantation.
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Affiliation(s)
- Marcos Almeida Meniconi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | - Alberto Colella Cervone
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Dorival Julio Della Togna
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Fausto Feres
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
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Erbano BO, Schio NA, Lopes RD, Bignoto TC, Olandoski M, da Luz RSB, de Carvalho GD, Erbano LHO, Ramos AIDO, Feres F, Faria JR, Baena CP, Siqueira DADA. Tricuspid Regurgitation and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2023; 120:e20220319. [PMID: 37556650 PMCID: PMC10382153 DOI: 10.36660/abc.20220319] [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: 07/01/2022] [Revised: 02/17/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear. OBJECTIVES To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality. METHODS Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%). RESULTS Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92). CONCLUSIONS Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario.
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Affiliation(s)
- Bruna Olandoski Erbano
- Programa de Pós-GraduaçãoInstituto Dante Pazzanese de CardiologiaUniversidade de São PauloSão PauloSPBrasilPrograma de Pós-Graduação do Instituto Dante Pazzanese de Cardiologia associado à Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nicolle Amboni Schio
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Renato Delascio Lopes
- Duke University HospitalDurhamNorth CarolinaEUADuke University Hospital, Durham, North Carolina – EUA
| | - Tiago Costa Bignoto
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Marcia Olandoski
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Raquel Silva Brito da Luz
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Guilherme Dagostin de Carvalho
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | | | - Fausto Feres
- Programa de Pós-GraduaçãoInstituto Dante Pazzanese de CardiologiaUniversidade de São PauloSão PauloSPBrasilPrograma de Pós-Graduação do Instituto Dante Pazzanese de Cardiologia associado à Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Rocha Faria
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
| | - Cristina Pellegrino Baena
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR – Brasil
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Centemero M, Urdanetta LR, Maschiarelli I, Barreto R, Mendez CA, Delamain JH, Wolf PW, Terrível D, Feres F, Chamié D. Sinus of Valsalva Pseudoaneurysm: An Unusual Cause of Complete Heart Block. JACC Case Rep 2023; 14:101832. [PMID: 37077873 PMCID: PMC10106995 DOI: 10.1016/j.jaccas.2023.101832] [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: 07/07/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
We present a case of a young man with complete atrioventricular block and aneurysm of the right sinus of Valsalva penetrating the interventricular septum and causing severe aortic regurgitation. Chest trauma and inflammatory or infectious diseases are potential causes. Bentall-de Bono surgical repair was performed. Anatomopathologic analysis demonstrated fibrosis, hyalinization, and extensive myxoid material. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Marinella Centemero
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- Address for correspondence: Dr Marinella Centemero, Interventional Cardiology Department, Dante Pazzanese Institute of Cardiology, 500 Dr. Dante Pazzanese Avenue, Ibirapuera, São Paulo, Brazil.
| | - Luis Rafael Urdanetta
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Ibraim Maschiarelli
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Rodrigo Barreto
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Carlos Alberto Mendez
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Jose Henrique Delamain
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Plínio Whitaker Wolf
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Daniel Terrível
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Fausto Feres
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Daniel Chamié
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Freitas RAP, Tanajura LF, Mehran R, Chamié D, Chaves A, Centemero M, Braga S, Costa R, Cao D, Sousa A, Feres F, Costa JR. Ioxaglate Versus IoDixanol for the Prevention of Contrast-Induced Nephropathy: The IDPC Trial. J Invasive Cardiol 2023:JIC20230516-2. [PMID: 37220640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Despite the potential benefits of percutaneous procedures for the assessment and treatment of coronary artery disease, these interventions require the use of iodine contrast, which might lead to contrast-induced nephropathy (CIN) and increased risk of dialysis and major adverse cardiac events (MACE). AIMS We sought to compare two different iodine contrasts (low vs. iso-osmolar) for the prevention of CIN among high-risk patients. METHODS This is a single-center, randomized (1:1) trial comparing consecutive patients at high risk for CIN referred to percutaneous coronary diagnostic and/or therapeutic procedures with low (ioxaglate) vs. iso-osmolarity (iodixanol) iodine contrast. High risk was defined by the presence of at least one of the following conditions: age >70 years, diabetes mellitus, non-dialytic chronic kidney disease, chronic heart failure, cardiogenic shock, and acute coronary syndrome (ACS). The primary endpoint was the occurrence of CIN, defined as a >25% relative increase and/or >0.5 mg/dL absolute increase in creatinine (Cr) levels compared with baseline between the 2nd and 5th day after contrast media administration. RESULTS A total of 2,268 patients were enrolled. Mean age was 67 years. Diabetes mellitus (53%), non-dialytic chronic kidney disease (31%), and ACS (39%) were highly prevalent. The mean volume of contrast media was 89 ml ± 48.6. CIN occurred in 15% of all patients, with no significant difference regarding the type of contrast used (iso = 15.2% vs. low = 15.1%, P>.99). Differences were not observed in specific subgroups such as diabetics, elderly, and ACS patients. At 30-day follow-up, 13 patients in the iso-osmolarity group and 11 in low-osmolarity group required dialysis (P =.8). There were 37 (3.3%) deaths in the iso-osmolarity cohort vs. 29 (2.6%) in the low-osmolarity group (P =.4). CONCLUSION Among patients at high risk for CIN, the incidence of this complication was 15%, and independent of the use of low- or iso-osmolar contrast.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - J Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia, Av. Dr Dante Pazzaensse, 500, Ibirapuera, São Paulo - SP, Brazil.
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7
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Silva GBG, Meneguz-Moreno RA, Costa R, Chamié D, Dangas G, Manica A, Arruda JA, Sousa AGMR, Feres F, Costa JR. Serial Assessment of Coronary Artery Healing of a Biodegradable Polymer Drug-Eluting Stent at 1, 2, and 3 Months by Optical Coherence Tomography (OCT)-The REPAIR Trial. J Invasive Cardiol 2023; 35:E225-E233. [PMID: 36920890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Although first-generation drug-eluting stent (DES) devices have effectively achieved their main goal of reducing restenosis, their safety has been limited by suboptimal polymer biocompatibility, delayed stent endothelialization, and local drug toxicity, which ultimately prompted the development of new-generation DES options carrying biocompatible or even biodegradable polymers. AIMS We sought to assess the vessel-healing pattern of the novel sirolimus-eluting Inspiron DES (Scitech Medical) using serial optical coherence tomography (OCT) and assuming the hypothesis that this thin-strut (75-μm), biodegradable-polymer DES promotes a faster healing, with very early strut coverage. METHODS This is a prospective, multicenter, open-label, single-arm study enrolling 68 patients who underwent percutaneous coronary intervention guided by OCT. These patients were consecutively assigned into 3 groups. The first group had its OCT imaging follow-up performed at 3 months, the second group at 2 months, and the third group at 1 month. RESULTS Mean age was 59.5 years, 70.6% were male, 41.2% had type 2 diabetes, and 29.4% presented with acute coronary syndrome. A total of 72 lesions were treated and 1.06 stents were implanted per patient. OCT assessment of the stents at 1, 2, and 3 months showed a strut coverage of 90.41%, 93.96%, and 97.21%, respectively (P=.04). CONCLUSION The Inspiron DES showed an early strut healing pattern, with >90% of the struts covered by neointima within the first month and with almost all struts covered by the third month.
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8
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Pereira FJSS, Menezes MP, Naranjo GCS, Delamain JHH, Costa JR, Issa M, Amato VL, Feres F, Farsky PS. Change of Strategy in Coronary Artery Bypass Graft Surgery Waiting List during the COVID-19 Pandemic: One-Year Follow-Up. Arq Bras Cardiol 2023; 120:e20220582. [PMID: 37098990 PMCID: PMC10263414 DOI: 10.36660/abc.20220582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/03/2022] [Accepted: 01/11/2023] [Indexed: 04/27/2023] Open
Affiliation(s)
| | - Marília Prudente Menezes
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | | | - José Ribamar Costa
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Mario Issa
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Vivian Lerner Amato
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Fausto Feres
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Pedro Silvio Farsky
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
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9
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Hortegal RA, Hossri C, Giolo L, Cancellier R, Gun C, Assef J, Moriya HT, Franchini KG, Feres F, Meneghelo R. Mechanical dispersion is a superior echocardiographic feature to predict exercise capacity in preclinical and overt heart failure with preserved ejection fraction. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-02830-0. [PMID: 36997835 DOI: 10.1007/s10554-023-02830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Heart Failure with Preserved Ejection Fraction (HFpEF) is a syndrome characterized by different degrees of exercise intolerance, which leads to poor quality of life and prognosis. Recently, the European score (HFA-PEFF) was proposed to standardize the diagnosis of HFpEF. Even though Global Longitudinal Strain (GLS) is a component of HFA-PEFF, the role of other strain parameters, such as Mechanical Dispersion (MD), has yet to be studied. In this study, we aimed to compare MD and other features from the HFA-PEFF according to their association with exercise capacity in an outpatient population of subjects at risk or suspected HFpEF. METHODS This is a single-center cross-sectional study performed in an outpatient population of 144 subjects with a median age of 57 years, 58% females, referred to the Echocardiography and Cardiopulmonary Exercise Test to investigate HFpEF. RESULTS MD had a higher correlation to Peak VO2 (r=-0.43) when compared to GLS (r=-0.26), MD presented a significant correlation to Ventilatory Anaerobic Threshold (VAT) (r=-0.20; p = 0.04), while GLS showed no correlation (r=-0.14; p = 0.15). Neither MD nor GLS showed a correlation with the time to recover VO2 after exercise (T1/2). In Receiver Operator Characteristic (ROC) analysis, MD presented superior performance to GLS to predict Peak VO2 (AUC: 0.77 vs. 0.62), VAT (AUC: 0.61 vs. 0.57), and T1/2 (AUC: 0.64 vs. 0.57). Adding MD to HFA-PEFF improved the model performance (AUC from 0.77 to 0.81). CONCLUSION MD presented a higher association with Peak VO2 when compared to GLS and most features from the HFA-PEFF. Adding MD to the HFA-PEFF improved the model performance.
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Affiliation(s)
- Renato A Hortegal
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil.
| | - Carlos Hossri
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Luiz Giolo
- Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
| | - Renato Cancellier
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Carlos Gun
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Jorge Assef
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Henrique T Moriya
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
- Biomedical Engineering Laboratory, University of Sao Paulo, São Paulo, Brazil
| | - Kleber G Franchini
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
- Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Romeu Meneghelo
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
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10
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Hortegal RA, Valeri R, Grizante M, Cancellier R, Uemoto V, Gun C, Assef J, Moriya H, Meneghelo R, Feres F, Franchini KG. Afterload increase challenge unmasks systolic abnormalities in heart failure with preserved ejection fraction. Int J Cardiol 2023; 380:20-27. [PMID: 36958396 DOI: 10.1016/j.ijcard.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/26/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Provocative maneuvers have the potential to overcome the low sensitivity of resting echocardiography and biomarkers in the detection of heart failure with preserved ejection fraction (HFpEF). We investigate the mechanical response of the left ventricle to an afterload challenge in patients with preclinical and early-stage HFpEF (es-HFpEF). METHODS Three groups of patients (non-HFpEF - n = 42, pre-HFpEF - n = 43, and es-HFpEF - n = 39) underwent echocardiography at rest and during an afterload challenge induced by handgrip maneuver combined with pneumatic constriction of limbs. RESULTS Patients in the non-HF group displayed a median ΔLPSS = -4% (IQR: -10%, +2%), LPSS rest<16% in 3/42(7%) and LPSS stress<16% in 6/43(14%). Subjects in the pre-HFpEF group displayed median ΔLPSS = -3% (IQR: -10%, +5%) LPSS rest<16% in 13/43(30%) and LPSS stress<16% in 19/43 (44%). 11/43 (25%) subjects in this group increased at least one absolute point in LPSS during stress. Patients in es-HFpEF group displayed a median ΔLPSS = -10% (IQR: -18%, -1%), LPSS rest<16% in 15/39(38%) and LPSS stress<16% in 25/39(64%). Changes in LPSS (ΔLPSS) were significantly greater in es-HFpEF than pre-HFpEF (p = 0.022). In multivariate analysis, this group effect was maintained after adjustment of the LPSS for systolic blood pressure, use of β-blockers, LV mass, RWT, age, and sex. CONCLUSION Our data suggest that patients with HFpEF have a marked decrease in peak strain during acute pressure overload. Longitudinal studies are needed to test and compare the clinical impact of each pattern in early and long-term follow-ups.
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Affiliation(s)
| | - Renata Valeri
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | | | | | - Vinícius Uemoto
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Carlos Gun
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Jorge Assef
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Henrique Moriya
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil; Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Romeu Meneghelo
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Fausto Feres
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Kleber G Franchini
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil; Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
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11
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Costa F, Montalto C, Branca M, Hong SJ, Watanabe H, Franzone A, Vranckx P, Hahn JY, Gwon HC, Feres F, Jang Y, De Luca G, Kedhi E, Cao D, Steg PG, Bhatt DL, Stone GW, Micari A, Windecker S, Kimura T, Hong MK, Mehran R, Valgimigli M. Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials. Eur Heart J 2023; 44:954-968. [PMID: 36477292 DOI: 10.1093/eurheartj/ehac706] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. METHODS AND RESULTS A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. CONCLUSION In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen. STUDY REGISTRATION PROSPERO registration number CRD42021284004.
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Affiliation(s)
- Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina 98100, Italy
| | - Claudio Montalto
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | | | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | | | - Elvin Kedhi
- Clinique Hopitaliere Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Davide Cao
- Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina 98100, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Marco Valgimigli
- Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
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12
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da Silva RL, Dangas GD, de Andrade PB, Joaquim RM, da Silva TRW, Fattah T, Pereira VC, Zanella RA, Sousa AGM, Feres F, Costa JR. Effect of randomized prophylactic nitroglycerin on radial artery spasm during transradial catheterization: An analysis based on operator experience. Catheter Cardiovasc Interv 2023; 101:579-586. [PMID: 36640416 DOI: 10.1002/ccd.30541] [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: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 μg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.
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Affiliation(s)
- Roberto L da Silva
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil.,Department of Cardiology, Hospital Universitário Prof. Polydoro Ernani de São Thiago, Florianópolis, Santa Catarina, Brazil
| | - George D Dangas
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Pedro B de Andrade
- Department of Interventional Cardiology, Santa Casa de Marília, Marília, São Paulo, Brazil
| | - Rodrigo M Joaquim
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil.,Department of Cardiology, Hospital Universitário Prof. Polydoro Ernani de São Thiago, Florianópolis, Santa Catarina, Brazil
| | - Thais R W da Silva
- Department of Cardiology, Hospital Universitário Prof. Polydoro Ernani de São Thiago, Florianópolis, Santa Catarina, Brazil
| | - Tammuz Fattah
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil
| | - Vanderlei C Pereira
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil
| | - Ricardo A Zanella
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil
| | - Amanda G M Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Fausto Feres
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - José R Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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Cervone AC, Feres F, Delamain JH, Tanajura LF, Braga SN, Ohe L, de Ribamar Costa J, Siqueira DA. CRT-700.49 Routine Ultrasound-Guided Femoral Access and Use of One Vascular Closure Device for Femoral Hemostasis After TAVR: Feasibility And Safety. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.340] [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: 02/22/2023]
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Nogueira MF, Andalaft R, Hinkelmann Berbert G, Valdigem B, Pinto VBC, Moretti MP, Felicioni SP, Fernandes RC, Franca FFAC, Freitas RV, Feres F. Electrocardiographic profile of asymptomatic adolescents by the TELE ECG system in Brazil: analysis of 11058 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.395] [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
Introduction
The search for markers that can serve as screening methods for young practitioners of physical activity has always raised an intense discussion between pediatricians and cardiologists. Thus, the ideal investigation algorithm should identify patients at high risk also among asymptomatic patients and be of low cost to society. This would only be possible by including a low cost diagnostic method and largely accessible. In this context, telemedicine systems and in particular tele-electrocardiogram (tele-EKG) systems have low cost and agility and can collaborate to solve this problem.
Purpose
To analyze the electrocardiographic pattern in asymptomatic patients aged between 10 and 20 years old who underwent EKG by the tele-EKG system between 2007 and 2014
Methods
All EKG valid results from asymptomatic patients aged between 10 and 20 years old from 2007 and 2014 sent to the tele-EKG system of a large tertiary hospital were analysed aiming to determine the prevalence of abnormal findings.
Results
Of the 797,115 exams on the analysed period 25,326 were from patients aged between 10 and 20 years old and 11,058 (55% male) of them were asymptomatic. Regarding disorders of rhythm, ventricular arrhythmias were found in 0.54% and atrial premature beats in 0.47% of the exams. There were 5 episodes of supraventricular tachycardia (0.04%) and one episode of atrial fibrillation. Atrioventricular blocks were: first degree (0.71%) and second degree (0.03%). There was 1 case of 2:1 AV Block and 1 case of advanced AV block. Short PR interval was observed in 0.76% of the exams, with 15 of them showing ventricular pre-excitation (0.13%). Regarding morphological changes in EKG pattern, right bundle branch disorders were present in 7.5% of the patients and left bundle branch in 0.04%. Right bundle branch block occurred in 0.63% and left bundle branch block in only 1 case. Repolarization changes occurred in 1.8% of patients. We found left ventricular overload in 0.25% and right ventricular overload in 0.14% of cases. Only 5 patients had typical EKG of septal hypertrophy (0.045%). There were 1751 diagnostics overall, representing 15.8% of the sample. The most prevalent was right bundle branch abnormalities, followed by repolarization abnormalities (graphic below).
Conclusion
EKG screening in asymptomatic adolescents is a low cost and feasible method to identify individuals with electrical alterations and who require detailed clinical evaluation. This also may contribute to reduce risk of sudden events during sports activities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M F Nogueira
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - R Andalaft
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | | | - B Valdigem
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - V B C Pinto
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - M P Moretti
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - S P Felicioni
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - R C Fernandes
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - F F A C Franca
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - R V Freitas
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
| | - F Feres
- Instituto Dante Pazzanese De Cardiologia , Sao Paulo , Brazil
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Tritschler T, Patel A, Kraaijpoel N, Bhatt DL, De Luca G, Di Santo P, Feres F, Costa RA, Hibbert B, Isshiki T, Le Gal G, Castellucci LA. Case‐fatality rate of major bleeding events in patients on dual antiplatelet therapy after percutaneous coronary intervention: A systematic review and meta‐analysis. Res Pract Thromb Haemost 2022; 6:e12834. [PMID: 36349260 PMCID: PMC9634492 DOI: 10.1002/rth2.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background Assessment of the case-fatality rate (CFR) of major bleeding on dual antiplatelet therapy (DAPT) may improve balancing risks and benefits of different durations of DAPT following percutaneous coronary intervention (PCI). Objectives To determine the CFR of major bleeding in patients on DAPT after PCI and to compare rates among different durations of DAPT. Methods Medline, Embase, and CENTRAL were searched from inception to August 2021 for randomized trials that reported fatal bleeding among patients who were randomized to ≥1 month of DAPT following PCI. Summary estimates for CFRs of major bleeding were calculated using the random-effects inverse-variance method. Statistical heterogeneity was evaluated using the I 2 statistic. Results Of 2777 citations obtained by the search, 15 (48%) of 31 potentially eligible studies were excluded because fatal bleeding was not reported, leaving 16 studies that were included in the analysis. Overall, there were 823 major bleeding events including 91 fatal events in 48,884 patients who were assigned to receive DAPT during study follow-up. The CFR of major bleeding was 10.8% (95% confidence interval [CI], 7.1-16.2; I 2 = 50%) in the entire study population, and 13.8% (95% CI, 6.5-27.1; I 2 = 28%), 11.2% (95% CI, 6.7-18.0; I 2 = 0%), and 5.8% (95% CI, 3.0-11.1; I 2 = 0%) in those on short-term (≤6 months; n = 16,553), standard-term (12 months; n = 19,453), and long-term DAPT (>12 months; n = 10,238), respectively. Conclusion Fatal bleeding is not reported in many studies evaluating DAPT after PCI. The CFR of major bleeding on DAPT is substantial and may be higher in the first 12 months of DAPT than during long-term DAPT.
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Affiliation(s)
- Tobias Tritschler
- Department of General Internal Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Anuj Patel
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Noémie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School, Boston Boston Massachusetts USA
| | - Giuseppe De Luca
- Division of Cardiology Azienda Ospedaliera‐Universitaria “Maggiore della Carità”, Eastern Piedmont University Novara Italy
| | | | - Fausto Feres
- Department of Invasive Cardiology Instituto Dante Pazzanese de Cardiologia Sao Paulo Brazil
| | - Ricardo A. Costa
- Department of Invasive Cardiology Instituto Dante Pazzanese de Cardiologia Sao Paulo Brazil
| | | | - Takaaki Isshiki
- Division of Cardiology Teikyo University Hospital Tokyo Japan
| | - Grégoire Le Gal
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Lana A. Castellucci
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
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Léo da Silva R, Joaquim R, da Silva T, Beraldo P, Pereira V, Zanella R, Sousa A, Feres F, Costa J. TCT-590 Comparison of Different Doses of Heparin on Prevention of Radial Artery Occlusion After Diagnostic Transradial Catheterization. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Cervone AC, de Alvim Siqueira DA, Ohe LN, de Oliveira GFF, Delamain JHH, Bandeira DGSF, della Togna DJ, de O Ramos AI, Assef JE, Braga SLN, Masciarelli Pinto I, Issa M, Feres F. Early Single-Center Experience With Meril's Myval Transcatheter Heart Valve. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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da Silva RL, de Andrade PB, Dangas G, Joaquim RM, da Silva TRW, Vieira RG, Pereira VC, Sousa AGM, Feres F, Costa JR. Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin: PATENS Trial. JACC Cardiovasc Interv 2022; 15:1009-1018. [PMID: 35331684 DOI: 10.1016/j.jcin.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether administration of nitroglycerin at the beginning or end of a transradial approach (TRA) procedure would preserve radial patency. BACKGROUND The TRA is becoming the preferred vascular access route in coronary interventions. Radial artery occlusion (RAO) is the most frequent complication. Routine vasodilator treatment aims to reduce spasm and possibly prevent RAO. METHODS The authors designed a prospective, multicenter, randomized, double-blind, 2-by-2 factorial, placebo-controlled trial encompassing patients undergoing the TRA. Patients were randomized to either 500 μg nitroglycerin or placebo; each arm was also subrandomized to early (upon sheath insertion) or late (right before sheath removal) nitroglycerin administration to evaluate the superiority of nitroglycerin in the prevention of RAO with 24 hours on Doppler ultrasound. RESULTS A total of 2,040 patients were enrolled. RAO occurred in 49 patients (2.4%). Fifteen of these patients (30.6%) showed re-establishment of flow at 30 days. Nitroglycerin, compared with placebo, did not reduce the risk for RAO at either of the 2 time points (early, 2.5% vs 2.3% [P = 0.66]; late, 2.3% vs 2.5% [P = 0.66]). By multivariable analysis, the presence of spasm (OR: 3.53; 95% CI: 1.87-6.65; P < 0.001) and access achieved with more than 1 puncture attempt (OR: 2.58; 95% CI: 1.43-4.66; P = 0.002) were independent predictors of RAO. CONCLUSIONS The routine use of nitroglycerin was not associated with a reduction in the rate of RAO, regardless of the time of administration (at the beginning or end of the TRA procedure).
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Affiliation(s)
- Roberto L da Silva
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Brazil; Department of Cardiology, Hospital Universitário Prof Polydoro Ernani de São Thiago, Florianópolis, Brazil.
| | - Pedro B de Andrade
- Department of Interventional Cardiology, Santa Casa de Marília, Marília, Brazil
| | - George Dangas
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Rodrigo M Joaquim
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Brazil; Department of Cardiology, Hospital Universitário Prof Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Thaís R W da Silva
- Department of Cardiology, Hospital Universitário Prof Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Ramiro G Vieira
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | - Vanderlei C Pereira
- Department of Interventional Cardiology, Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | - Amanda G M Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Fausto Feres
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - José R Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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da Silva RL, de Andrade PB, Abizaid A, Joaquim RDM, da Silva TRW, Fattah T, Vieira RG, Pereira VC, Sousa AG, Feres F, de Ribamar Costa J. EFFECT OF PROPHYLACTIC NITROGLYCERIN ON RADIAL ARTERY SPASM DURING TRANSRADIAL CATHETERIZATION: AN ANALYSIS BASED ON OPERATOR EXPERIENCE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01820-4] [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: 11/17/2022]
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Freitas RAP, Tanajura LF, Valente B, Centemero MP, Chamie D, Feres F, Souza AGMR, de Ribamar Costa J. IOXAGLATE VERSUS IODIXANOL IN THE PREVENTION OF CONTRAST-INDUCED NEPHROPATHY: RANDOMIZED IDPC TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01610-2] [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: 11/26/2022]
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21
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Cervone AC, Alexandre de Alvim Siqueira D, Ohe LN, Fernandes de Oliveira GF, Herrmann Delamain JH, Sabino Ferreira Bandeira DG, Júlio della Togna D, Isabel de O Ramos A, Assef JE, Navarro Braga SL, Pinto IM, Issa M, Feres F. CRT-700.18 Early Single-Center Experience With Meril's Myval Transcatheter Heart Valve. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Palmerini T, Bruno AG, Redfors B, Valgimigli M, Taglieri N, Feres F, Abizaid A, Costa R, Gilard M, Morice MC, Hong MK, Kim BK, Jang Y, Kim HS, Park KW, Colombo A, Chieffo A, Nakamura M, Kotinkaduwa LN, Nardi E, Saia F, Gasparini M, Rizzello G, Weisz G, Kirtane AJ, Mehran R, Witzenbichler B, Galiè N, Stone GW. Risk-Benefit of 1-Year DAPT After DES Implantation in Patients Stratified by Bleeding and Ischemic Risk. J Am Coll Cardiol 2021; 78:1968-1986. [PMID: 34763774 DOI: 10.1016/j.jacc.2021.08.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although a 1-year duration of dual antiplatelet therapy (DAPT) is used in many patients after drug-eluting stent (DES) implantation, the evidence supporting this duration is uncertain. OBJECTIVES The authors investigated the risk-benefit profile of 1-year vs ≤6-month DAPT after DES using 2 novel scores to risk stratify bleeding and ischemic events. METHODS Ischemic and bleeding risk scores were generated from ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), a multicenter, international, "all-comers" registry that enrolled 8,665 patients treated with DES. The risk-benefit profile of 1-year vs ≤6-month DAPT was then investigated across risk strata from an individual patient data pooled dataset of 7 randomized trials that enrolled 15,083 patients treated with DES. RESULTS In the derivation cohort, the ischemic score and the bleeding score had c-indexes of 0.76 and 0.66, respectively, and both were well calibrated. In the pooled dataset, no significant difference was apparent in any ischemic endpoint between 1-year and ≤6-month DAPT, regardless of the risk strata. In the overall dataset, there was no significant difference in the risk of clinically relevant bleeding between 1-year and ≤6-month DAPT; however, among 2,508 patients at increased risk of bleeding, 1-year compared with ≤6-month DAPT was associated with greater bleeding (HR: 2.80; 95% CI: 1.12-7.13) without a reduced risk of ischemic events in any risk strata, including those with acute coronary syndromes. These results were consistent in a network meta-analysis. CONCLUSIONS In the present large-scale study, compared with ≤6-month DAPT, a 1-year duration of DAPT was not associated with reduced adverse ischemic events in any risk strata (including acute coronary syndromes) but was associated with greater bleeding in patients at increased risk of bleeding.
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Affiliation(s)
- Tullio Palmerini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | | | - Ricardo Costa
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Martine Gilard
- Department of Cardiology, Brest University, Brest, France
| | | | - Myeong-Ki Hong
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Elena Nardi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gasparini
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Torino, Italy
| | - Giulia Rizzello
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Torino, Italy
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Roxana Mehran
- Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nazzareno Galiè
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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23
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Léo da Silva R, Joaquim R, Beraldo P, Abizaid A, Vieira R, Pereira V, Viana R, Sousa A, Feres F, Costa J. TCT-322 Prevention of Radial Artery Occlusion After Transradial Access Using Nitroglycerin (Patens Trial). J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1175] [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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24
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Guimarães PO, de Souza FR, Lopes RD, Bittar C, Cardozo FA, Caramelli B, Calderaro D, Albuquerque CP, Drager LF, Feres F, Baracioli L, Feitosa Filho G, Barbosa RR, Ribeiro HB, Ribeiro E, Alves RJ, Soeiro A, Faillace B, Figueiredo E, Damiani LP, do Val RM, Huemer N, Nicolai LG, Hajjar LA, Abizaid A, Kalil Filho R. High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study. Int J Cardiol Heart Vasc 2021; 36:100853. [PMID: 34345648 PMCID: PMC8321709 DOI: 10.1016/j.ijcha.2021.100853] [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] [Received: 04/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients. METHODS We included patients with COVID-19 and high risk features according to clinical and/or laboratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death. RESULTS A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality. CONCLUSIONS This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveillance and potential subsequent interventional therapies.
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Affiliation(s)
- Patrícia O. Guimarães
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Francis R. de Souza
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renato D. Lopes
- Duke University Medical Center – Duke Clinical Research Institute, Duke Health, Durham, United States
| | - Cristina Bittar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francisco A. Cardozo
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cícero P. Albuquerque
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano F. Drager
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Luciano Baracioli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Lucas P. Damiani
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata M. do Val
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natassja Huemer
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lisiê G. Nicolai
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ludhmila A. Hajjar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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25
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Chamié D, Petraco R, Feres F. Response by Chamié et al to Letter Regarding Article, "Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions: The iSIGHT Randomized Trial". Circ Cardiovasc Interv 2021; 14:e011004. [PMID: 34182787 DOI: 10.1161/circinterventions.121.011004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Daniel Chamié
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (D.C., F.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.P.)
| | - Fausto Feres
- Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (D.C., F.F.)
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26
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Chamié D, Costa JR, Damiani LP, Siqueira D, Braga S, Costa R, Seligman H, Brito F, Barreto G, Staico R, Feres F, Petraco R, Abizaid A. Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions: The iSIGHT Randomized Trial. Circ Cardiovasc Interv 2021; 14:e009452. [PMID: 33685212 DOI: 10.1161/circinterventions.120.009452] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Daniel Chamié
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - J Ribamar Costa
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Lucas P Damiani
- Research Institute, Hospital do Coração, Sao Paulo, Brazil (L.P.D.)
| | - Dimytri Siqueira
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Sérgio Braga
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Ricardo Costa
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Henry Seligman
- International Centre for Circulatory Health, Imperial College London, United Kingdom (H.S., R.P.)
| | - Freddy Brito
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Guilherme Barreto
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Rodolfo Staico
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Fausto Feres
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
| | - Ricardo Petraco
- International Centre for Circulatory Health, Imperial College London, United Kingdom (H.S., R.P.)
| | - Alexandre Abizaid
- Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.)
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27
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Chamié D, Oliveira F, Braga S, Costa JR, Siqueira DAAD, Staico R, Costa R, Maldonado G, Tanajura LFL, Centemero MP, Chaves ÁJ, Abizaid ACSL, Freitas RAP, Coelho NT, Ohe LN, Abboud C, Feres F. Adapted Catheterization Laboratory Practices during the COVID-19 Pandemic: The Instituto Dante Pazzanese de Cardiologia Protocol. Arq Bras Cardiol 2020; 115:558-568. [PMID: 33027381 PMCID: PMC9363089 DOI: 10.36660/abc.20200489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/24/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Daniel Chamié
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | | | - Sérgio Braga
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | | | | | - Rodolfo Staico
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | - Ricardo Costa
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | - Galo Maldonado
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | | | | | | | | | | | | | | | - Cely Abboud
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
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28
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Siqueira DAAD, Ramos AIDO, Feres F. Transseptal, Transcatheter Mitral Valve-In-Valve Replacement: Ready for Prime Time Treatment of Bioprosthetic Valve Failure in Brazil? Arq Bras Cardiol 2020; 115:525-527. [PMID: 33027376 PMCID: PMC9363078 DOI: 10.36660/abc.20200575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia - Cardiologia Invasiva,São Paulo, SP - Brasil
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29
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Valgimigli M, Garcia-Garcia HM, Vrijens B, Vranckx P, McFadden EP, Costa F, Pieper K, Vock DM, Zhang M, Van Es GA, Tricoci P, Baber U, Steg G, Montalescot G, Angiolillo DJ, Serruys PW, Farb A, Windecker S, Kastrati A, Colombo A, Feres F, Jüni P, Stone GW, Bhatt DL, Mehran R, Tijssen JGP. Standardized classification and framework for reporting, interpreting, and analysing medication non-adherence in cardiovascular clinical trials: a consensus report from the Non-adherence Academic Research Consortium (NARC). Eur Heart J 2020; 40:2070-2085. [PMID: 29992264 DOI: 10.1093/eurheartj/ehy377] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 02/12/2018] [Revised: 03/20/2018] [Accepted: 07/04/2018] [Indexed: 01/02/2023] Open
Abstract
Non-adherence has been well recognized for years to be a common issue that significantly impacts clinical outcomes and health care costs. Medication adherence is remarkably low even in the controlled environment of clinical trials where it has potentially complex major implications. Collection of non-adherence data diverge markedly among cardiovascular randomized trials and, even where collected, is rarely incorporated in the statistical analysis to test the consistency of the primary endpoint(s). The imprecision introduced by the inconsistent assessment of non-adherence in clinical trials might confound the estimate of the calculated efficacy of the study drug. Hence, clinical trials may not accurately answer the scientific question posed by regulators, who seek an accurate estimate of the true efficacy and safety of treatment, or the question posed by payers, who want a reliable estimate of the effectiveness of treatment in the marketplace after approval. The Non-adherence Academic Research Consortium is a collaboration among leading academic research organizations, representatives from the U.S. Food and Drug Administration and physician-scientists from the USA and Europe. One in-person meeting was held in Madrid, Spain, culminating in a document describing consensus recommendations for reporting, collecting, and analysing adherence endpoints across clinical trials. The adoption of these recommendations will afford robustness and consistency in the comparative safety and effectiveness evaluation of investigational drugs from early development to post-marketing approval studies. These principles may be useful for regulatory assessment, as well as for monitoring local and regional outcomes to guide quality improvement initiatives.
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Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Hector M Garcia-Garcia
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Bernard Vrijens
- Department of Biostatistics, University of Liège, Liège, Wallonia, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium
| | | | - Francesco Costa
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.,Department of Clinical and Experimental Medicine, Policlinic "G Martino", University of Messina, Italy
| | - Karen Pieper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Pierluigi Tricoci
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Usman Baber
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriel Steg
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Andrew Farb
- Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, Food and Drug Administration
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonio Colombo
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Department, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Fausto Feres
- Division of Cardiology, Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Peter Jüni
- Institute of Primary Health Care, Toronto, Canada
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan G P Tijssen
- European Cardiovascular Research Institute, Rotterdam, The Netherlands.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Costa F, van Klaveren D, Colombo A, Feres F, Räber L, Pilgrim T, Hong MK, Kim HS, Windecker S, Steyerberg EW, Valgimigli M. A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making. Am Heart J 2020; 223:44-47. [PMID: 32151822 DOI: 10.1016/j.ahj.2020.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 10/30/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022]
Abstract
The originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy1 duration after PCI. It is unknown if a simplified version of the score based on 4 factors (age, hemoglobin, creatinine clearance, prior bleeding), and lacking white-blood cell count, retains potential to guide DAPT duration. The 4-item PRECISE-DAPT was used to categorize 10,081 patients who were randomized to short (3-6 months) or long (12-24 months) DAPT regimen according to high (HBR defined by PRECISE-DAPT ≥25 points) or non-high bleeding risk (PRECISE-DAPT<25) status. Long treatment duration was associated with higher bleeding rates in HBR (ARD +2.22% [95% CI +0.53 to +3.90]) but not in non-HBR patients (ARD +0.25% [-0.14 to +0.64]; pint = 0.026), and associated with lower ischemic risks in non-HBR (ARD -1.44% [95% CI -2.56 to -0.31]), but not in HBR patients (ARD +1.16% [-1.91 to +4.22]; pint = 0.11). Only non-HBR patients experienced lower net clinical adverse events (NACE) with longer DAPT (pint = 0.043). A 4-item simplified version of the PRECISE-DAPT score retains the potential to categorize patients who benefit from prolonged DAPT without concomitant bleeding liability from those who do not.
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Affiliation(s)
- Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Italy
| | - David van Klaveren
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Lorenz Räber
- Swiss Cardiovascular Center Bern, Bern University Hospital
| | - Thomas Pilgrim
- Swiss Cardiovascular Center Bern, Bern University Hospital
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Ewout W Steyerberg
- Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, The Netherlands
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31
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da Silva RL, de Andrade PB, Abizaid AAC, Britto PFR, Filippini FB, Viana RMM, Sousa AGM, Feres F, Costa JR. Comparison of Minimum Pressure and Patent Hemostasis on Radial Artery Occlusion After Transradial Catheterization. J Invasive Cardiol 2020; 32:147-152. [PMID: 32160152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial catheterization. BACKGROUND RAO is an infrequent complication of transradial procedures. One of the strategies used to reduce this complication is the patent hemostasis technique. Use of minimum pressure in hemostatic wristband, without monitoring patency, might have the same efficacy for preventing RAO. METHODS This is a multicenter study encompassing patients submitted to transradial catheterization. After pneumatic wristband application, the band was deflated to the lowest allowable volume while preserving hemostasis. Radial artery patency was subsequently evaluated. The group with no return of plethysmographic curve was labeled "minimum pressure," and the group in which the signal returned was labeled "patent hemostasis." RAO was verified by Doppler evaluation within the first 24 hours of the procedure. RESULTS A total of 1082 patients were enrolled, with mean age of 61.4 ± 10.4 years. The majority (61.0%) were male and 34.5% had diabetes. Patent hemostasis was achieved in only 213 cases (20%). Early RAO occurred in 16 patients (1.8%) in the minimum pressure group and in 4 patients (1.9%) in the patent hemostasis group (P=.97). No major bleeding was observed among the entire cohort. EASY scale for hematoma grade was similar between the cohorts (EASY grades 1-3: 7.0% in the minimum pressure group vs 7.5% in the patent hemostasis group; P=.96). CONCLUSION Checking radial patency during hemostatic compression may not be necessary after the procedure when adopting a mild and short hemostatic compression.
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Affiliation(s)
- Roberto L da Silva
- Instituto de Cardiologia de Santa Catarina, Rua Adolfo Donato da Silva, s/n. Praia Comprida, São José, Santa Catarina. CEP 88103-901.
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de Ribamar Costa J, Penalva R, Valente B, Tanajura LF, Centemero M, Abizaid A, Feres F, Souza AGMR, França JI. RANDOMIZED COMPARISON BETWEEN LOW (IOXIGLATO)AND ISO (IODIXANOL) OSMOLARITY IODINE CONTRAST FOR PREVENTION OF CONTRAT-INDUCED NEPHROPATY AMONG HIGH-RISK PATIENTS SUBMITTED TO PERCUTANEOUS CORONARY DIAGNOSTIC OR THERAPEUTIC PROCEDURES (THE IDPC TRIAL). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32135-5] [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: 10/24/2022]
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de Ribamar Costa J, Rossi R, Nigro C, França JI, Braga S, Bergwerk A, Goncalves MA, da Silva EV, de Almeida MH, Sousa A, Feres F, Abizaid A. EFFECT OF SEVOFLURANE ON CKMB RELEASE AFTER PCI WITH DRUG-ELUTING STENTS: A RANDOMISED TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31749-6] [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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34
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Costa F, Van Klaveren D, Feres F, James S, Räber L, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M. Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting. J Am Coll Cardiol 2020; 73:741-754. [PMID: 30784667 DOI: 10.1016/j.jacc.2018.11.048] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [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: 08/15/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. OBJECTIVES This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PREdicting bleeding Complications in patients undergoing stent Implantation and SubsequEnt Dual AntiPlatelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. METHODS Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. RESULTS Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: -3.86%; 95% confidence interval: -7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: -1.14%; 95% confidence interval: -2.26 to -0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. CONCLUSIONS Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT.
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Affiliation(s)
- Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino," University of Messina, Messina, Italy; Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - David Van Klaveren
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lorenz Räber
- Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Philippe Gabriel Steg
- FACT, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université Paris-Diderot, Bichat Hospital, Paris, France
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Stephan Windecker
- Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Ewout W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
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Mehta S, Botelho R, Fernandez F, Feres F, Abizaid A, Cade J, Perin M, Prudente M, Cavalcanti R, Dusilek C, Nola F, Pisana L, Safie R, Aboushi H, Lopez C. P5241Balancing limited resources, infra-structure deficits & cultural differences in sustaining the growth of LATIN telemedicine program. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0214] [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: 11/12/2022] Open
Abstract
Abstract
Background
In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform with efficient, cost-effective and scalable programs. We present our data with screening >780,000 patients with innovative hub and spoke strategies.
Purpose
Scientifically pristine protocols, rigorous training, unflinching quality assurance, technology upgrades and education of broad stakeholders are essential attributes for creating population-based AMI programs.
Methods
Latin America Telemedicine Infarct Network (LATIN) required methodical groundwork during a 12-month pilot prior to its formal launch and sustenance for 5 years. It involved scrupulous site selection, technology, and telemedicine optimization and system-wide process metrics. Spokes are the LATIN nucleus and require constant (3-T) training: Triage, Telemedicine, and Transportation. Plus, a mandatory deconstruct of their role in LATIN, of urgent transfer and desist non-critical care. Telemedicine requires constant upgrading of platform, tele-equipment and cloud computing. Ambulance availability is a constant challenge as is the battle with payers. Data entry has required meticulous training and oversight. Strict QA processes have monitored critical metrics: Spokes (Door In Door Out, DIDO and Transport Times); Hubs (Door to Balloon Times, D2B); Telemedicine Platform (Time to Telemedicine Diagnosis, TTD).
Results
Linear growth is observed in the number of sites and telemedicine screenings with simultaneous and sustained improvements in D2B and TTD. 784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). With expanded reach, 8,440 (1.08%) patients were diagnosed and 3,924 (46.5%) urgently reperfused, including 3,048 (77.7%) with PCI. Time to Telemedicine Diagnosis (TTD) was 3 min, tele-accuracy 98.9%, D2B 51 min and in-hospital morality 5.2%. Major reasons for non-treatment were insurance, lack of ICU beds and delayed presentation.
Conclusions
As other regions of the world develop large, population-based AMI management initiatives, LATIN can provide important lessons in the sustainability of these processes.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | - A Abizaid
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Cavalcanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - R Safie
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Feres F, Abizaid A, Cade J, Perin M, Prudente M, Cavalcanti R, Dusilek C, Frauenfelder A, Matheus C, Pinto G, Mazzini J, Quintero S. P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0228] [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
The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders.
Purpose
To maximally harness the vast possibilities of telemedicine for improving AMI care.
Methods
During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile.
Results
784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation.
Conclusions
LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | - A Abizaid
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Cavalcanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Feres F, Abizaid A, Cade J, Perin M, Prudente M, Calvanti R, Dusilek C, Matheus C, Ceschim M, Vieira D, Torres MA, Mazzini J. P1751LATIN - A template for effective AMI management in developing countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0505] [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
In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform the situation through an efficient, cost-effective and scalable program called the Latin America Telemedicine Infarct Network (LATIN). We present our innovative hub-spoke strategy, that has served >780,000 patients.
Purpose
To use telemedicine protocols to demonstrate appropriate access to quality AMI care, encompassing remote areas.
Methods
LATIN required technology and process metrics optimization as well as a scrupulous site selection, during a 12-month pilot. Spokes represent our strategy's nucleus; they consist of small, rural clinics and resource-limited facilities that are connected to PCI-capable hubs. Spokes require constant (3-T) training: Triage, Telemedicine, and Transportation. The latter two categories are the most challenging because they demand constant upgrading.
Results
784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). A total of 8,440 (1.08%) patients were diagnosed with AMI; 3,924 (46.5%) were urgently reperfused including 3,048 (77.7%) who underwent PCI. Globally, Time to Telemedicine Diagnosis (TTD) was 3 min exhibiting 98.9% tele-accuracy, D2B was 51 min, additionally, in-hospital mortality was 5.2%. Major reasons for non-treatment of patients were insurance, lack of ICU beds and delayed presentation.
Conclusions
LATIN is a valuable healthcare system prototype for developing countries. Our hub-spoke strategy focuses on providing adequate AMI management for populations. However, aspects such as ambulance availability, insurance denial and lack of ICU beds must be targeted to improve performance.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | - A Abizaid
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Calvanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Alcocer Gamba M, De Los Rios O, Ricalde A, Acosta H, Villagra L, Perin M, Feres F, Frauenfelder A, Matheus C, Ceschim M, Pinto G, Mazzini J. P575Merging technologies to provide Mexico an innovative nationwide AMI management network. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
“Cόdigo Infarto”, the vast patient-centric, app-based, educational crusade of the Mexican Society of Interventional Cardiology (SOCIME) has been combined with the Latin America Telemedicine Infarct Network (LATIN) to create a comprehensive, national AMI program for Mexico.
Purpose
To demonstrate the benefits of amalgamating educational initiatives of national cardiology societies with a global telemedicine program for improving AMI management.
Methods
“Cόdigo Infarto” App connects patients to a network of several hundred cardiologists and 250 Primary PCI-capable labs. LATIN provides the partnership with its robust telemedicine platform, a hub-spoke strategy that supports patient's access to appropriate medical management. Remotely located experts, in Colombia, provide urgent EKG diagnosis via tele-consultation to the entire LATIN Mexico network. They activate ambulance dispatch and implement guideline-based protocols.
Results
Numerous “Cόdigo Infarto” sites have incorporated LATIN to provide a simple and accelerated management of AMI patients. Currently, the partnership (7 hubs, 78 spokes) has screened 19,886 patients. A total of 359 STEMI cases (1.8%) have been diagnosed; 118 patients (33%) were urgently reperfused, Primary PCI was performed in 74% of the latter cases. D2B time was 41 min. Reasons for the lack of treatment include delayed presentation, lack of ICU beds and insurance denials. Currently, these constraints are being methodically probed. Updated results will be available at time of presentation.
Conclusions
The synergy of the AMI initiative for Mexico provides a template for similar initiatives in developing countries.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | | | | | - A Ricalde
- Lumen Foundation, Miami, United States of America
| | - H Acosta
- Lumen Foundation, Miami, United States of America
| | - L Villagra
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
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Mavrakanas TA, Chatzizisis YS, Gariani K, Kereiakes DJ, Gargiulo G, Helft G, Gilard M, Feres F, Costa RA, Morice MC, Georges JL, Valgimigli M, Bhatt DL, Mauri L, Charytan DM. Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents: A Meta-Analysis. Clin J Am Soc Nephrol 2019; 14:810-822. [PMID: 31010936 PMCID: PMC6556713 DOI: 10.2215/cjn.12901018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. RESULTS Five randomized trials were included (1902 patients with CKD). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD. CONCLUSIONS Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.
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Affiliation(s)
- Thomas A Mavrakanas
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; .,Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Karim Gariani
- Division of Diabetes and Endocrinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio
| | - Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Gérard Helft
- Institute of Cardiology, University Hospitals Pitié-Salpêtrière- Charles Foix (Public Assistance- Hospitals of Paris), Sorbonne University, Paris, France
| | - Martine Gilard
- Division of Cardiology, Regional University Hospital La Cavale Blanche, Brest, France
| | - Fausto Feres
- Institute Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo, Brazil
| | - Ricardo A Costa
- Institute Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Laura Mauri
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David M Charytan
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Baim Institute for Clinical Research, Boston, Massachusetts; and.,Division of Nephrology, New York University Langone Medical Center, New York, New York
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Kang J, Park K, Palmerini T, Stone G, Lee M, Colombo A, Chieffo A, Feres F, Abizaid A, Bhatt D, Valgimigli M, Hong MK, Jang Y, Gilard M, Morice MC, Park DW, Park SJ, Jeong YH, Park J, Koo BK, Kim HS. Racial Differences in Ischaemia/Bleeding Risk Trade-Off during Anti-Platelet Therapy: Individual Patient Level Landmark Meta-Analysis from Seven RCTs. Thromb Haemost 2018; 119:149-162. [DOI: 10.1055/s-0038-1676545] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background Prolonged dual anti-platelet therapy (DAPT) is intended to reduce ischaemic events, at the cost of an increased bleeding risk in patients undergoing percutaneous coronary intervention (PCI). In this study, we evaluated whether race influences the ischaemia/bleeding risk trade-off.
Methods We searched for randomized clinical trials (RCTs) comparing DAPT duration after PCI. To compare the benefit or harm between DAPT duration by race, individual patient-level landmark meta-analysis was performed after discontinuation of the shorter duration DAPT group in each RCT. The primary ischaemic endpoint was major adverse cardiac events (MACEs), and the primary bleeding endpoint was major bleeding events (clinicaltrials.gov NCT03338335).
Results Seven RCTs including 16,518 patients (8,605 East Asians, 7,913 non-East Asians) were pooled. MACE occurred more frequently in non-East Asians (0.8% vs. 1.8%, p < 0.001), while major bleeding events occurred more frequently in East Asians (0.6% vs. 0.3%, p = 0.001). In Cox proportional hazards model, prolonged DAPT significantly increased the risk of major bleeding in East Asians (hazard ratio [HR], 2.843, 95% confidence interval [CI], 1.474–5.152, p = 0.002), but not in non-East Asians (HR, 1.375, 95% CI, 0.523–3.616, p = 0.523). East Asians had a higher median probability risk ratio of bleeding to ischaemia (0.66 vs. 0.15), and the proportion of patients with higher probability of bleeding than ischaemia was significantly higher in East Asians (32.3% vs. 0.4%, p < 0.001).
Conclusion We suggest that the ischaemia/bleeding trade-off may be different between East Asians and non-East Asians. In East Asians, prolonged DAPT may have no effect in reducing the ischaemic risk, while significantly increases the bleeding risk.
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Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tullio Palmerini
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Gregg Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, United States
| | - Michael Lee
- Division of Cardiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, United States
| | | | | | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Deepak Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Marco Valgimigli
- Swiss Cardiovascular Center, Bern University Hospital, Bern University, Bern, Switzerland
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Martine Gilard
- Department of Cardiology, Brest University, Brest, France
| | | | - Duk-Woo Park
- The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Seung-Jung Park
- The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Mehta S, Botelho R, Fernandez F, Prudente M, Cavalcanti R, Cade J, Dusilek C, Feres F, Alcocer-Gamba M, Estrada A, Torres M, Rodriguez D, Aboushi H. TCT-439 Long-term Savings with Telemedicine STEMI Networks. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1605] [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: 11/28/2022]
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Mehta S, Botelho R, Fernandez F, Prudente M, Cavalcanti R, Cade J, Dusilek C, Feres F, Alcocer-Gamba M, Estrada A, Torres M, Rodriguez D. TCT-50 Fiscal Impact of Avoiding Unnecessary Transfers and Hospitalization in STEMI Interventions– Results from Latin America Telemedicine Infarct Network (LATIN). J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1136] [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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Mehta S, Botelho R, Fernandez F, Prudente M, Cavalcanti R, Cade J, Dusilek C, Feres F, Abizaid A, Alcocer-Gamba M, Estrada A, Torres M, Rodriguez D, Cortizo Vidal LL, Vieira D. TCT-49 Transformational Pathways for AMI Management in Developing Countries - Rolling 600,000 Remote Patient Encounters to D2B Interventions. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1135] [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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Mehta S, Botelho R, Fernandez F, Prudente M, Cavalcanti R, Cade J, Dusilek C, Feres F, Alcocer-Gamba M, Estrada A, Torres M, Rodriguez D, Vieira D. TCT-441 SOCIME + LATIN: Partners for Comprehensive, Nationwide AMI Care in Mexico. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1607] [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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45
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Costa F, Van Klaveren D, Feres F, Raber L, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Stone GW, Bhatt DL, Windecker S, Steyerberg E, Valgimigli M. P3179Exploring the value of the PRECISE-DAPT score after complex percutaneous coronary intervention to inform dual antiplatelet therapy duration decision-making. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Costa
- University of Messina, Messina, Italy
| | | | - F Feres
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | - L Raber
- Bern University Hospital, Bern, Switzerland
| | - T Pilgrim
- Bern University Hospital, Bern, Switzerland
| | - M K Hong
- Severance Hospital, Seoul, Korea Republic of
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea Republic of
| | - A Colombo
- EMO-GVM Heart Center Columbus, Milan, Italy
| | - P G Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - G W Stone
- Columbia University Medical Center, New York, United States of America
| | - D L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | | | - E Steyerberg
- Leiden University Medical Center, Leiden, Netherlands
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46
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Mehta S, Rodriguez D, Botelho R, Fernandez F, Dusilek C, Cardoso R, Lacativa M, Perin M, Feres F, Abizaid A, Campos C, Vega R, Bojanini F, Alcocer M, Estrada A. P4491Telemedicine-guided STEMI networks - Pragmatic and cost-effective strategies for population-based AMI care in developing countries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - D Rodriguez
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Triangulo Heart Institute, Uberlandia, Brazil
| | | | - C Dusilek
- Hospital de Santa Marcelina, Sao Paulo, Brazil
| | - R Cardoso
- Unimed-Rio Hospital, Rio de Janeiro, Brazil
| | - M Lacativa
- Hospital do Coração de Duque de Caxias, Rio de Janeiro, Brazil
| | - M Perin
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - F Feres
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | - A Abizaid
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | - C Campos
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - R Vega
- ITMS Colombia, Bogota, Colombia
| | - F Bojanini
- Unidad de Cardiología del Camino Universitario Adelita de Char, Barranquilla, Colombia, Barranquilla, Colombia
| | - M Alcocer
- Instituto del Corazon de Queretaro, Queretaro, Mexico
| | - A Estrada
- Instituto Metropolitano del Corazon, Tuxtla, Mexico
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Bustamante Prota Filho LE, Cezar Viana Queiroz C, Costa Wohnrath F, Amaral Carvalho Carboni F, Reis Cunha Da Costa G, Ileana Panchano Castro J, Sousa Da Silva W, Meneguz Moreno R, Ribamar Costa Junior J, Antonio Cunha Abizaid A, Feres F. P6033Development of immediate and late predictor score of success after percutaneous mitral valvoplasty in patients with mitral stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6033] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - F Feres
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
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48
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Valdigem BP, Correa EB, Moreira DAR, Andalaft RB, Masciarelli Pinto IB, Abizaid AAC, Cano MN, Armaganijan LV, Paladino Filho TA, Verissimo O, Lebihan D, Feres F, Viesi JHZ, Nigro Neto C, Barreto RBM. P4588Echo guided septal radiofrequency ablation for treatment of obstructive hypertrophic cardiomiopathy - Case series. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B P Valdigem
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - E B Correa
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - D A R Moreira
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - R B Andalaft
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | | | - A A C Abizaid
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - M N Cano
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - L V Armaganijan
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - T A Paladino Filho
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - O Verissimo
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - D Lebihan
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - F Feres
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - J H Z Viesi
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - C Nigro Neto
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
| | - R B M Barreto
- Institute Dante Pazzanese of Cardiology, Electrophysiology, Sao Paulo, Brazil
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49
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Piccolo R, Feres F, Abizaid A, Gilard M, Morice MC, Hong MK, Kim HS, Colombo A, Bhatt DL, Palmerini T, Stone GW, Windecker S, Valgimigli M. Risk of Early Adverse Events After Clopidogrel Discontinuation in Patients Undergoing Short-Term Dual Antiplatelet Therapy: An Individual Participant Data Analysis. JACC Cardiovasc Interv 2018; 10:1621-1630. [PMID: 28838471 DOI: 10.1016/j.jcin.2017.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The study sought to evaluate the presence of a clinically relevant rebound phenomenon after dual antiplatelet therapy (DAPT) discontinuation in randomized trials. BACKGROUND It is currently unknown whether clopidogrel discontinuation after short-term DAPT is associated with an early hazard of ischemic events. METHODS The authors performed an individual participant data analysis and aggregate meta-analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of cardiac death, myocardial infarction (MI), or stroke. RESULTS The study included 11,473 PCI patients with individual participant data from 6 randomized trials comparing short-term DAPT (3 or 6 months) versus long-term DAPT (12 months or more). During the first 90 days following clopidogrel discontinuation, there was no significant increase in the risk of MACCE between patients randomized to short-term DAPT compared with long-term DAPT (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.71 to 1.98; p = 0.52; absolute risk difference 0.10%; 95% CI: -0.16% to 0.36%). The risk of MI or stent thrombosis was similar among patients randomized to short-term DAPT versus long-term DAPT (HR: 0.93; 95% CI: 0.46 to 1.90; p = 0.85). In the aggregate data meta-analysis of 11 trials including 38,919 patients, a higher risk of early MACCE was observed after long-term (≥12 months) DAPT duration (HR: 2.28; 95% CI: 1.69 to 3.09; p < 0.001) but not short-term (<12 months) DAPT duration (HR: 1.08; 95% CI: 0.67 to 1.74; p for interaction = 0.036). CONCLUSIONS Among patients undergoing PCI with predominantly new-generation DES, discontinuation of clopidogrel after 3 or 6 months DAPT duration was not associated with an early increase in adverse clinical events. An early increase in MACCE was observed after long-term (≥12 months) DAPT exposure.
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Affiliation(s)
- Raffaele Piccolo
- Department of Cardiology, University Hospital of Bern, University of Bern, Switzerland
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Martine Gilard
- Department of Cardiology, CHU de la Cavale Blanche, Brest, France
| | | | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Tullio Palmerini
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Stephan Windecker
- Department of Cardiology, University Hospital of Bern, University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, University Hospital of Bern, University of Bern, Switzerland.
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50
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Lee SY, Hong MK, Palmerini T, Kim HS, Valgimigli M, Feres F, Colombo A, Gilard M, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Stone GW. Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients. JACC Cardiovasc Interv 2018; 11:435-443. [DOI: 10.1016/j.jcin.2017.10.015] [Citation(s) in RCA: 30] [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] [Received: 09/11/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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