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Kuku KO, Garcia-Garcia HM, Doros G, Mintz GS, Ali ZA, Singh S, Cate TT, Powers ER, Wong SC, Wykrzykowska J, Shah PR, Sum ST, Torguson R, Di Mario C, Waksman R. Two-year plaque level outcomes involving the left anterior descending artery: insights from the Lipid-Rich Plaque study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1303] [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
Coronary artery disease (CAD) is more frequently seen in the left anterior descending artery (LAD). LAD disease resulting in an acute anterior wall myocardial infarction (MI) is associated with a low left ventricular ejection fraction and invariably a worsened prognosis. The Lipid Rich Plaque (LRP) Study reported the strong association between NIRS-IVUS derived max4mmLCBI and future plaque events in non-culprit vessels.
Objective
To report the events involving the LAD versus the other major coronary vessels in the Lipid-Rich Plaque study.
Methods
The LRP Study was an international, multicenter, prospective cohort study conducted in patients with suspected CAD who underwent cardiac catheterization with possible ad hoc percutaneous coronary intervention (PCI) for an index event. Plaque level events within the subsequent 2 years were adjudicated. Plaque level events were defined as the composite of cardiac death, cardiac arrest, non-fatal MI, acute coronary syndrome (ACS), revascularization by coronary artery bypass grafting (CABG) or PCI, and rehospitalization for angina with >20% stenosis progression related and unrelated to the treatment at index procedure. All together these events were reported as Non-Culprit Lesion-related Major Adverse Cardiac Events (NC-MACE). Prespecified subgroups of segments were defined according to LAD (vs. non-LAD) with maxLCBI4mm ≤400 or >400.
Results
A total of 57 plaque events occurred through 2 years of follow-up. More than half occurred in the LAD, followed by the LCX and the RCA. There were more, albeit non-statistically significant, lipid-rich plaques in the LAD, compared to the LCX and RCA: 12.5% vs 10.4% and 11.3%, respectively, p=0.097. A minimum lumen area (MLA) ≤4mm2 within the maxLCBI4mm was observed more in the LAD and the LCX, compared to the RCA: 34.1% vs 25.9% vs 13.7%, respectively, p<0.001. Lipid rich plaque (maxLCBI4mm>400) was present in 20/57 (35.1%) of the plaque level events, a large PB (≥70%) was present in 6/57 (10.5%), and a small MLA (≤4mm2) was present in 26/57 (45.6%). Out of the 57 plaque level events, 4 (7%) had all three high risk plaque characteristics.
Presence of an elevated maxLCBI4mm (>400) was predictive of NC-MACE in all subgroups (for LAD >400 HR 4.32; 95% CI (1.93, 9.69; p 0.0004) and for the non-LAD >400 HR 2.56; 95% CI (1.06, 6.17; p 0.0354).
Conclusion
Non-culprit segments in the LAD with maxLCBI4mm values >400 were more frequently associated with plaque level events than in the lipid -rich segments in the other epicardial vessels. This sub-study results point to the unequivocal value of maxLCBI4mm>400 in predicting future plaque level events especially in the LAD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Infraredx Plaque Events-Ware Segment Locations
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Affiliation(s)
- K O Kuku
- MedStar Health Research Institute, Cardiovascular Imaging, Washington DC, United States of America
| | - H M Garcia-Garcia
- Medstar Washington Hospital Centre, Interventional Cardiology, Washington, DC, United States of America
| | - G Doros
- Medstar Washington Hospital Centre, Interventional Cardiology, Washington, DC, United States of America
| | - G S Mintz
- Medstar Washington Hospital Centre, Interventional Cardiology, Washington, DC, United States of America
| | - Z A Ali
- Columbia University, Interventional Cardiology, New York, United States of America
| | - S Singh
- Long Island Jewish, Interventional Cardiology, New York, United States of America
| | - T T Cate
- University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - E R Powers
- Medical University of South Carolina, Cardiology, Charleston, United States of America
| | - S C Wong
- Weill Cornell Medicine, Cardiology, New York, United States of America
| | - J Wykrzykowska
- University Medical Center Groningen, Cardiology, Groningen, Netherlands (The)
| | - P R Shah
- Infraredx, Boston, United States of America
| | - S T Sum
- Infraredx, Boston, United States of America
| | - R Torguson
- Icahn School of Medicine at Mount Sinai, Cardiology, New York, United States of America
| | - C Di Mario
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - R Waksman
- Medstar Washington Hospital Centre, Interventional Cardiology, Washington, DC, United States of America
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Gao C, Kerkmeijer L, Tijssen R, Kraak R, Tijssen J, Onuma Y, Chevalier B, West N, Morice M, De Winter R, Smits P, Wykrzykowska J, Van Geuns R. Impact of diabetes mellitus on 2-year outcomes of Absorb BVS compared to Xience EES: a pooled analysis of the COMPARE-ABSORB and AIDA trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2546] [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 and purpose
Diabetes mellitus (DM) is associated with increased risk of cardiovascular events after percutaneous coronary intervention (PCI). To evaluate the impact of Absorb bioresorbable vascular scaffold (BVS) in patients with DM, we aimed to compare the 2-year outcomes of Absorb BVS versus 2nd generation drug eluting stents Xience (EES) by pooling diabetic patients treated with BVS or EES from two large, randomized controlled trial.
Methods
Patients with medically-treated DM and treated by Absorb BVS in the COMPARE-ABSORB and AIDA trial were pooled for analysis. The primary efficacy outcomes measure was target lesion failure (cardiac death, target-vessel myocardial infarction or target lesion revascularization), and the primary safety outcome measure was device thrombosis at 2-year follow-up.
Results
Out of a total 3515 enrolled subjects in the two trials, 913 were diabetics. Compared with the non-diabetic patients, those with DM were older, more often to have a history of hypercholesterolemia, chronic renal failure, stroke, hypertension, heart failure, peripheral vascular disease and previous PCI. At 2-years, target lesion failure occurred in 10.8% of BVS DM patients and 7.6% of EES DM patients (adjusted HR 1.43, 95% CI: 0.87–2.34, P=0.115). The 2-year rates of cardiac death (2.4% vs 1.6%, P=0.385), TV-MI (5% vs 1.6%, P=0.123) and TLR (7.8% vs 5.8%, P=0.416) showed not significant difference. The 2-year incidence of definite device thrombosis was 3.2% in Absorb BVS versus 0.7% in Xience EES (adjusted HR 4.77, 95% CI: 1.01–22.43, P=0.048).
Conclusion
This pooling of the diabetic patients from two large scale RCTs compared BVS versus 2nd generation DES, showed an increased rate of device thrombosis in BVS-treated patients at 2 years.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
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Affiliation(s)
- C Gao
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | | | | | - R Kraak
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - J Tijssen
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | | | - N West
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - M.C Morice
- Cardiovascular European Research Center, Massy, France
| | | | - P Smits
- Maasstad Hospital, Rotterdam, Netherlands (The)
| | | | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
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Kerkmeijer L, Tijssen R, Kraak R, Hofma S, Arkenbout E, Van Der Schaaf R, Weevers A, Tijssen J, Piek J, Henriques J, De Winter R, Wykrzykowska J. Four-year results of the AIDA trial: comparison of Absorb bioresorbable scaffold with Xience everolimus-eluting metallic stent in daily clinical practice. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2539] [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
Aims
Absorb bioresorbable scaffold (BRS) related events were noticed between 1 and 3 years – the approximate time of active scaffold bioresorption. This resulted in the recommendation for 3 year DAPT after Absorb BRS implantation. We aimed to evaluate the safety and efficacy of the Absorb BRS in comparison with Xience everolimus-eluting stent (EES) at 4 years follow-up in large unselected population. In addition, we aimed to assess the value of prolonged DAPT against scaffold thrombosis.
Methods
AIDA was an investigator-initiated, non-inferiority, multicenter, randomized, all-comers trial. Target vessel failure (a composite of cardiac death, target-vessel myocardial infarction and target-vessel revascularization) and device thrombosis at 4-year follow-up are the primary focus of this analysis. During the trial recommendation for DAPT was changed to up to 3-years post Absorb BVS implantation. Whether this adaption influenced the results after Absorb BVS will be assessed.
Results
Between August 2013 and December 2015, 1,845 patients were enrolled, of whom 924 were randomized to treatment with Absorb BRS and 921 to Xience EES. The baseline characteristics in the two study arms were well balanced. Of all patients, 18% had diabetes mellitus, more than 50% presented with ACS and the median SYNTAX score was 11. In the Absorb BRS arm, 97% of lesions were predilated and in 74% post-dilatation was performed. Four-year clinical outcomes are currently being adjudicated by an independent clinical event committee. The results will be available at EuroPCR 2020.
Conclusions
Absorb BRS is associated with higher rates of scaffold thrombosis throughout 3-year of follow-up. The performance of Absorb BRS beyond 3-years, in comparison with the Xience EES, in a large unselected population will be presented. (ClinicalTrials.gov Identifier: NCT01858077)
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
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Affiliation(s)
- L.S.M Kerkmeijer
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R.Y.G Tijssen
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R.P Kraak
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - S.H Hofma
- Medical Center Leeuwarden, Leeuwarden, Netherlands (The)
| | | | | | - A.P.J Weevers
- Albert Schweitzer Hospital, Dordrecht, Netherlands (The)
| | - J.G.P Tijssen
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J.J Piek
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J.P.S Henriques
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R.J De Winter
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J.J Wykrzykowska
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
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Kerkmeijer L, Chao G, Tijssen R, Gori T, Kraak R, Tijssen J, Onuma Y, Chevalier B, De Winter R, Smits P, Van Geuns R, Wykrzykowska J. Two-year clinical performance of Absorb BVS compared to Xience EES in ST-segment elevation myocardial infarction: a pooled analysis of AIDA and COMPARE-ABSORB trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2544] [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
Bioresorbable vascular scaffolds (BVS) use appears theoretically attractive in patients presenting with ST-segment elevation myocardial infarction (STEMI) as acute lesions are generally composed of soft plaques, in which optimal BVS deployment and expansion is easier to achieve. Furthermore, those patients are generally younger and would benefit longer from the promise of vascular restoration therapy.
Purpose
In this patient level pooled analysis of two clinical trials, we evaluated the clinical outcomes of Absorb BVS versus Xience everolimus-eluting stent (EES) in STEMI patients at 2-year follow-up.
Methods
We performed an individual patient-level pooled analysis of the AIDA and COMPARE-ABSORB trials in which 3515 patient were randomly assigned to Absorb BVS (n=1772) or Xience EES (n=1743). Clinical outcomes in STEMI patients were analyzed by randomized treatment assignment cumulative through 2 years. The primary efficacy outcomes measure was target lesion failure (cardiac death, target-vessel myocardial infarction or target lesion revascularization), and the primary safety outcome measure was device thrombosis at 2-year follow-up.
Results
350 (19.8%) STEMI patients were allocated to Absorb BVS versus 328 (18.8%) to Xience EES. The mean age of patient presenting with STEMI was 60 years old, 76.0% were males and 15.3% had diabetes mellitus. At 2-years target lesion failure occurred in 8.4% of BVS STEMI patients and 6.2% of EES STEMI patients (p=0.253). The 2-year rates of cardiac death (2.6% vs 1.6%, p=0.332), TV-MI (4.7% vs 2.5%) and TLR (6.8% vs 4.1%) were not significantly different. The 2-year incidence of definite device thrombosis was 4.7% in Absorb BVS versus 1.8% in Xience EES (p=0.045).
Conclusion
In the present patient-level pooled analysis of the AIDA and COMPARE-Absorb trials, BVS was associated with increased rates of device thrombosis in STEMI patients compared to Xience EES.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
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Affiliation(s)
- L.S.M Kerkmeijer
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - G Chao
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - R Tijssen
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - T Gori
- University Medical Center Mainz, Mainz, Germany
| | - R.P Kraak
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J.G.P Tijssen
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - Y Onuma
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - R.J De Winter
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P Smits
- Maasstad Hospital, Rotterdam, Netherlands (The)
| | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - J.J Wykrzykowska
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
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Katagiri Y, Serruys PW, Tenekecioglu E, Asano T, Collet C, Miyazaki Y, Piek JJ, Wykrzykowska J, Chevalier B, Mintz G, Onuma Y. P6374Acute and long-term relocation of minimal lumen area after Absorb bioresorbable scaffold or Xience metallic stent implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6374] [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)
- Y Katagiri
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - P W Serruys
- Imperial College London, London, United Kingdom
| | | | - T Asano
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - C Collet
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - Y Miyazaki
- Erasmus Medical Center, Rotterdam, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - J Wykrzykowska
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - B Chevalier
- Institut Hospitalier Jacques Cartier, Massy, France
| | - G Mintz
- Cardiovascular Research Foundation, New York, United States of America
| | - Y Onuma
- Erasmus Medical Center, Rotterdam, Netherlands
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Wang W, Wykrzykowska J, Johnson T, Sen R, Sen J. A NF-kappa B/c-myc-dependent survival pathway is targeted by corticosteroids in immature thymocytes. J Immunol 1999; 162:314-22. [PMID: 9886401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Glucocorticoid hormones modulate T cell maturation in vivo. While low levels of hormones are required for appropriate T cell development, high levels of glucocorticoid hormones target immature developing thymocytes for cell death during systemic stress. In this report, we propose a molecular mechanism for the induction of apoptosis in CD4+CD8+ double-positive thymocytes by dexamethasone in vivo. Dexamethasone injection induced the expression of IkappaBalpha and IkappaBbeta in thymocytes and down-regulated NF-kappaB DNA binding activated by intrathymic signals. Down-regulation of NF-kappaB DNA binding preceded cell death, suggesting that NF-kappaB may be important for the survival of immature thymocytes. In addition, ex vivo treatment of thymocyte single-cell suspension with dexamethasone accelerated p65/RelA down-regulation and cell death. Conversely, NF-kappaB induction diminished dexamethasone-induced death. Expression of the c-myc proto-oncogene, a NF-kappaB target, was also reduced in thymocytes of dexamethasone-treated animals, and ectopic transgenic expression of c-myc in mice provided partial rescue of double-positive thymocytes from dexamethasone mediated cell death. These observations suggest that viability of CD4+CD8+ thymocytes may be maintained by an NF-kappaB/c-myc-dependent pathway in vivo.
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Affiliation(s)
- W Wang
- Rosenstiel Research Center and Department of Biology, Brandeis University, Waltham, MA 02254, USA
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