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Shlofmitz E, Garcia-Garcia HM, Chau K, Dakroub A, Thomas SV, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. Evaluation of the REDUCE-CLOT Study. JACC Cardiovasc Interv 2024:S1936-8798(24)00572-7. [PMID: 38639689 DOI: 10.1016/j.jcin.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
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Yeh RW, Shlofmitz R, Moses J, Bachinsky W, Dohad S, Rudick S, Stoler R, Jefferson BK, Nicholson W, Altman J, Bateman C, Krishnaswamy A, Grantham JA, Zidar FJ, Marso SP, Tremmel JA, Grines C, Ahmed MI, Latib A, Tehrani B, Abbott JD, Batchelor W, Underwood P, Allocco DJ, Kirtane AJ. Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: The AGENT IDE Randomized Clinical Trial. JAMA 2024; 331:1015-1024. [PMID: 38460161 PMCID: PMC10924708 DOI: 10.1001/jama.2024.1361] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
Importance Drug-coated balloons offer a potentially beneficial treatment strategy for the management of coronary in-stent restenosis. However, none have been previously evaluated or approved for use in coronary circulation in the United States. Objective To evaluate whether a paclitaxel-coated balloon is superior to an uncoated balloon in patients with in-stent restenosis undergoing percutaneous coronary intervention. Design, Setting, and Participants AGENT IDE, a multicenter randomized clinical trial, enrolled 600 patients with in-stent restenosis (lesion length <26 mm and reference vessel diameter >2.0 mm to ≤4.0 mm) at 40 centers across the United States between May 2021 and August 2022. One-year clinical follow-up was completed on October 2, 2023. Interventions Participants were randomized in a 2:1 allocation to undergo treatment with a paclitaxel-coated (n = 406) or an uncoated (n = 194) balloon. Main Outcomes and Measures The primary end point of 1-year target lesion failure-defined as the composite of ischemia-driven target lesion revascularization, target vessel-related myocardial infarction, or cardiac death-was tested for superiority. Results Among 600 randomized patients (mean age, 68 years; 157 females [26.2%]; 42 Black [7%], 35 Hispanic [6%] individuals), 574 (95.7%) completed 1-year follow-up. The primary end point at 1 year occurred in 17.9% in the paclitaxel-coated balloon group vs 28.6% in the uncoated balloon group, meeting the criteria for superiority (hazard ratio [HR], 0.59 [95% CI, 0.42-0.84]; 2-sided P = .003). Target lesion revascularization (13.0% vs 24.7%; HR, 0.50 [95% CI, 0.34-0.74]; P = .001) and target vessel-related myocardial infarction (5.8% vs 11.1%; HR, 0.51 [95% CI, 0.28-0.92]; P = .02) occurred less frequently among patients treated with paclitaxel-coated balloon. The rate of cardiac death was 2.9% vs 1.6% (HR, 1.75 [95% CI, 0.49-6.28]; P = .38) in the coated vs uncoated balloon groups, respectively. Conclusions and Relevance Among patients undergoing coronary angioplasty for in-stent restenosis, a paclitaxel-coated balloon was superior to an uncoated balloon with respect to the composite end point of target lesion failure. Paclitaxel-coated balloons are an effective treatment option for patients with coronary in-stent restenosis. Trial Registration ClinicalTrials.gov Identifier: NCT04647253.
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Affiliation(s)
- Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Jeffrey Moses
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | - Suhail Dohad
- Cedars Sinai Medical Center, Los Angeles, California
| | - Steven Rudick
- Lindner Center for Research and Education at Christ Hospital, Cincinnati, Ohio
| | - Robert Stoler
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | | | | | | | | | | | | | | | - Steven P. Marso
- Overland Park Regional Medical Center, Overland Park, Kansas
| | | | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Behnam Tehrani
- The Inova Schar Heart and Vascular Institute, Falls Church, Virginia
| | - J. Dawn Abbott
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence
| | - Wayne Batchelor
- The Inova Schar Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Ajay J. Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
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Visinoni ZM, Jurewitz DL, Kereiakes DJ, Shlofmitz R, Shlofmitz E, Ali Z, Hill J, Lee MS. Coronary intravascular lithotripsy for severe coronary artery calcification: The disrupt CAD I-IV trials. Cardiovasc Revasc Med 2024:S1553-8389(24)00076-9. [PMID: 38472025 DOI: 10.1016/j.carrev.2024.03.001] [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: 11/27/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Coronary artery calcification (CAC) severity is associated with increased vessel inflammation, atherosclerosis, stent failure, and risk of percutaneous coronary intervention-related complications. Current modalities for CAC modification include atherectomy techniques (rotational, orbital, and laser) and balloon modification (cutting and scoring). However, these methods are limited by their risk of slow flow/no reflow, coronary dissection, perforation, and myocardial infarction. Intravascular lithotripsy (IVL) emits high-energy sonic waves that induce calcium fractures within a target lesion to improve vessel compliance for stent placement. Low rates of major cardiac adverse events (MACE) and high rates of procedural and angiographic success were observed with IVL in the Disrupt CAD I-IV trials. Optical coherence tomography sub-studies identified calcium fracture as the likely etiology of improved vessel compliance and increased luminal diameter post-IVL. Rates of MACE, procedural, and angiographic success were consistent across the Disrupt CAD trials, suggesting IVL is less operator-dependent compared to other calcium-modifying techniques. Coronary IVL offers interventional cardiologists a safe and effective method of severe CAC modification, while providing reproducible outcomes.
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Affiliation(s)
- Zachary M Visinoni
- Sutter Roseville Medical Center, Roseville, CA, United States of America
| | - Daniel L Jurewitz
- Sutter Roseville Medical Center, Roseville, CA, United States of America
| | - Dean J Kereiakes
- The Carl and Edyth Lindner Research Center at The Christ Hospital, Cincinnati, OH, United States of America
| | - Richard Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Evan Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, United States of America
| | - Jonathan Hill
- Royal Bromptom Hospital, London, England, United Kingdom of Great Britain and Northern Ireland
| | - Michael S Lee
- Innovative Medical Solutions, Beverly Hills, CA, United States of America.
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Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrié D, Di Mario C, Dudek D, Escaned J, Fajadet J, Guagliumi G, Hill J, McEntegart M, Mashayekhi K, Mezilis N, Onuma Y, Reczuch K, Shlofmitz R, Stefanini G, Tarantini G, Toth GG, Vaquerizo B, Wijns W, Ribichini FL. Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group. Eur Heart J 2023; 44:4340-4356. [PMID: 37208199 DOI: 10.1093/eurheartj/ehad342] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 05/28/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Didier Carrié
- Service de Cardiologie B, CHU Rangueil, Université Paul Sabatier, Toulouse, France
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Jonathan Hill
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Institute Lahr/Baden, Lahr & Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Yoshinobu Onuma
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Krzyszstof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabor G Toth
- University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory, Corrib Core Laboratory and Curam, National University of Ireland, Galway, Ireland
| | - Flavio L Ribichini
- Cardiovascular Section of the Department of Medicine, University of Verona, Verona, Italy
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Angiolillo DJ, Cao D, Sartori S, Baber U, Dangas G, Zhang Z, Vogel B, Kunadian V, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Ielasi A, Stefanini GG, Pivato CA, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Steg PG, Pocock S, Mehran R. Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2514-2524. [PMID: 37879803 DOI: 10.1016/j.jcin.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases. OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI). METHODS In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables. RESULTS The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P = 0.566). CONCLUSIONS In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence.
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Affiliation(s)
- Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, Roslyn, New York, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kurt Huber
- 3rd Dept Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo A Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | | | - P Gabriel Steg
- Université de Paris and Assistance Paris-Hôpitaux de Paris, Paris, France
| | - Stuart Pocock
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Mendieta G, Mehta S, Baber U, Angiolillo DJ, Briguori C, Cohen D, Collier T, Dangas G, Dudek D, Escaned J, Gil R, Vogel B, Cao D, Spirito A, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Sardella G, Sartori S, Sharma S, Shlofmitz R, Steg PG, Han YL, Pocock S, Gibson CM, Mehran R. Bleeding and Ischemic Risks of Ticagrelor Monotherapy After Coronary Interventions. J Am Coll Cardiol 2023; 82:687-700. [PMID: 37587580 DOI: 10.1016/j.jacc.2023.05.062] [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: 03/07/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention), among high-risk patients undergoing percutaneous coronary intervention (PCI), ticagrelor monotherapy vs continuation of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor after completing a 3-month course of DAPT was associated with reduced bleeding, without an increase in ischemic events. OBJECTIVES This investigation sought to study the clinical benefit of ticagrelor monotherapy vs DAPT by simultaneously modeling its associated potential bleeding benefits and ischemic harms on an individual patient basis. METHODS Multivariable Cox regression models for: 1) Bleeding Academic Research Consortium type 2, 3, or 5 (BARC-2/3/5); and 2) cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke (major adverse cardiac and cerebrovascular event [MACCE]) were developed using stepwise forward variable selection. The coefficients in the BARC-2/3/5 and MACCE models were used to calculate bleeding and ischemic risk scores, respectively, for each patient (excluding the coefficient for randomized treatment). RESULTS In the total study group (N = 7,119), BARC-2/3/5 occurred in 391 (5.5%) patients, and MACCE occurred in 258 (3.6%). There was a consistent reduction in bleeding events associated with ticagrelor monotherapy compared with DAPT across both bleeding and ischemic risk strata (P interaction = 0.54 and 0.11, respectively). Importantly, this benefit associated with ticagrelor monotherapy was not offset by an increase in MACCE at any level of bleeding or ischemic risk. CONCLUSIONS Three months after PCI, discontinuing aspirin and maintaining ticagrelor monotherapy reduces bleeding in both higher-bleeding risk and lower-bleeding risk patients compared with continued DAPT. This benefit does not appear to be offset by greater ischemic risk. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242).
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Affiliation(s)
- Guiomar Mendieta
- National Center of Cardiovascular Investigations Carlos III (CNIC), Madrid, Spain
| | - Shamir Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | | | - David Cohen
- Department of Cardiology, St Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Health Research Institute, San Carlos Clinical Hospital (IDISCC), Complutense University of Madrid, Madrid, Spain
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt Huber
- Third Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Adnan Kastrati
- German Heart Center Munich, Technical University of Munich, German Center for Cardiovascular Research (DZHK) partner site Munich Heart Alliance, Munich, Germany
| | - Upendra Kaul
- Batra Hospital and Medical Research Center, New Delhi, India
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Moliterno
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Gennaro Sardella
- Department of Cardiology, Umberto I Polyclinical University, Rome, Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital, Roslyn, New York, USA
| | - P Gabriel Steg
- Paris Cité University, Public Hospitals of Paris (AP-HP), Bichat Hospital, Paris, France
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Michael Gibson
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Cao JJ, Shen L, Nguyen J, Rapelje K, Porter C, Shlofmitz E, Jeremias A, Cohen DJ, Ali ZA, Shlofmitz R. Accuracy and limitation of plaque detection by coronary CTA: a section-to-section comparison with optical coherence tomography. Sci Rep 2023; 13:11845. [PMID: 37481671 PMCID: PMC10363114 DOI: 10.1038/s41598-023-38675-9] [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: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
Plaques identified by Coronary CT angiography (CCTA) are important in clinical diagnosis and primary prevention. High-risk plaque features by CCTA have been extensively validated using optical coherence tomography (OCT). However, since their general diagnostic performance and limitations have not been fully investigated, we sought to compare CCTA with OCT among consecutive vessel sections. We retrospectively compared 188 consecutive plaques and 84 normal sections in 41 vessels from 40 consecutive patients referred for chest pain evaluation who had both CCTA and OCT with a median time lapse of 1 day. The distance to reference points were used to co-register between the modalities and the diagnostic performance of CCTA was evaluated against OCT. Plaque categories evaluated by CT were calcified, non-calcified and mixed. The diagnostic performance of CCTA was excellent for detecting any plaque identified by OCT with the sensitivity, specificity, negative and positive predictive values and accuracy of 92%, 98%, 99%, 84% and 93%, respectively. The lower than expected negative predictive value was due to failure of detecting sub-millimeter calcified (≤ 0.25 mm2) (N = 12) and non-calcified plaques (N = 4). Misclassification of plaque type accounted for majority of false negative findings (25/41, 61%) which was most prevalent among the mixed plaque (19/41, 46%). There was calcification within mixed plaques (N = 5) seen by CCTA but missed by OCT. Our findings suggest that CCTA is excellent at identifying coronary plaques except those sub-millimeter in size which likely represent very early atherosclerosis, although the clinical implication of very mild atherosclerosis is yet to be determined.
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Affiliation(s)
- J Jane Cao
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA.
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - James Nguyen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Kathleen Rapelje
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Craig Porter
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - David J Cohen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
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Karimi Galougahi K, Dakroub A, Chau K, Mathew R, Mullasari A, Singh B, Sengottuvelu G, Maehara A, Mintz G, Jeremias A, Shlofmitz E, West NEJ, Shlofmitz R, Ali ZA. Utility of optical coherence tomography in acute coronary syndromes. Catheter Cardiovasc Interv 2023. [PMID: 37245076 DOI: 10.1002/ccd.30656] [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: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/29/2023]
Abstract
Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologies. The purpose of this review is to summarize the data from clinical studies that have used high-resolution intravascular optical coherence tomography (OCT) to assess culprit plaque morphology in ACS. In addition, we discuss the utility of intravascular OCT for effective treatment of patients presenting with ACS, including the possibility of culprit lesion-based treatment by percutaneous coronary intervention.
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Affiliation(s)
| | | | - Karen Chau
- St Francis Hospital, Roslyn, New York, USA
| | | | - Ajit Mullasari
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | | | - Akiko Maehara
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | | | | | | | - Richard Shlofmitz
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
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9
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Ali ZA, Kereiakes D, Hill J, Saito S, Di Mario C, Honton B, Gonzalo N, Riley R, Maehara A, Matsumura M, Stone GW, Shlofmitz R. Safety and Effectiveness of Coronary Intravascular Lithotripsy for Treatment of Calcified Nodules. JACC Cardiovasc Interv 2023; 16:1122-1124. [PMID: 37029020 DOI: 10.1016/j.jcin.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 04/09/2023]
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10
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Sardella G, Beerkens FJ, Dangas G, Cao D, Baber U, Sartori S, Cohen DJ, Briguori C, Gil R, Nicolas J, Zhang Z, Dudek D, Kunadian V, Kornowski R, Weisz G, Claessen B, Marx S, Escaned J, Huber K, Collier T, Moliterno DJ, Ohman EM, Krucoff MW, Kastrati A, Steg PG, Angiolillo DJ, Mehta S, Shlofmitz R, Sharma S, Pocock S, Gibson CM, Mehran R. Ticagrelor with and without aspirin in patients with a prior coronary artery bypass graft undergoing percutaneous coronary intervention: the TWILIGHT-CABG study. EUROINTERVENTION 2022; 18:e897-e909. [PMID: 35979636 PMCID: PMC9743241 DOI: 10.4244/eij-d-22-00319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/12/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Prior coronary artery bypass graft surgery (CABG) patients undergoing percutaneous coronary intervention (PCI) are often older and present with multiple comorbidities. Ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) has emerged as an effective bleeding-avoidance strategy among high-risk patients. AIMS We aimed to examine the effects of ticagrelor with or without aspirin in prior CABG patients undergoing PCI within the TWILIGHT trial. METHODS After 3 months of ticagrelor plus aspirin, patients were randomised to either aspirin or placebo, in addition to ticagrelor, for 12 months and compared by prior CABG status. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was all-cause death, myocardial infarction (MI), or stroke. RESULTS Out of 7,119 patients, a total of 703 (10.8%) patients had prior CABG within the randomised cohort. Prior CABG patients had more comorbidities and a higher incidence of BARC type 2, 3, or 5 bleeding and death, MI or stroke at 1 year after randomisation, compared with patients without prior CABG. Ticagrelor monotherapy was associated with significantly less BARC 2, 3, or 5 bleeding among prior CABG patients compared with DAPT (4.9% vs 9.6%, hazard ratio [HR] 0.50, 95% confidence interval [CI]: 0.28 to 0.90; pinteraction=0.676) and similar rates of death, MI or stroke (10.0% vs 8.7%, HR 1.14, 95% CI: 0.70 to 1.87; pinteraction=0.484). When comparing target vessel type, treatment effects were consistent among graft- and native-vessel interventions. CONCLUSIONS In high-risk patients with prior CABG, ticagrelor monotherapy reduced bleeding without compromising ischaemic outcomes compared with ticagrelor plus aspirin.
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Affiliation(s)
- Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I University, Rome, Italy
| | - Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samantha Sartori
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J Cohen
- Department of Cardiology, St. Francis Hospital & Heart Center, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Johny Nicolas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dariusz Dudek
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Giora Weisz
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bimmer Claessen
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Steven Marx
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany and German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL , USA
| | - Shamir Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Samin Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Shlofmitz E, Croce K, Bezerra H, Sheth T, Chehab B, West NEJ, Shlofmitz R, Ali ZA. The MLD MAX OCT algorithm: An imaging-based workflow for percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S7-S13. [PMID: 36661367 DOI: 10.1002/ccd.30395] [Citation(s) in RCA: 2] [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: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
Although extensive clinical data support the utility of intravascular imaging to guide and optimize outcomes following percutaneous coronary interventions (PCI), clinical adoption remains limited. One of the primary reasons for limited utilization may be a lack of standardization on how to best integrate the data provided by intravascular imaging practically. Optical coherence tomography (OCT) offers a high-resolution intravascular imaging modality with integrated software automation that allows for incorporation of OCT into the routine workflow of PCIs. We suggest use of an algorithm called MLD MAX to incorporate OCT for imaging-guided interventions: the baseline OCT imaging run is intended to facilitate procedural planning and strategizing, consisting of assessment for predominant lesion morphology (M), measurement for stent length (L) and determination of stent diameter (D); the post-PCI OCT imaging run is designated for assessment of need for further optimization of stent result, and consists of analysis for medial dissections (M), adequate stent apposition (A) and stent expansion (X). Incorporation of the MLD MAX algorithm into daily practice guides an efficient and easily-memorable workflow for optimized PCI procedures.
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Affiliation(s)
- Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, New York, USA
| | - Kevin Croce
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Hiram Bezerra
- Division of Cardiovascular Medicine, Tampa General Hospital, University of South Florida Health, Tampa, Florida, USA
| | - Tej Sheth
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Bassem Chehab
- Division of Cardiovascular Medicine, Kansas Heart Hospital, Wichita, Kansas, USA
| | | | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, New York, USA
| | - Ziad A Ali
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, New York, USA.,Cardiovascular Research Foundation, Clinical Trial Center, New York City, New York, USA
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12
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Chandrasekhar J, Baber U, Sartori S, Goel R, Nicolas J, Vogel B, Snyder C, Kini A, Briguori C, Witzenbichler B, Iakovou I, Sardella G, Marzo K, DeFranco A, Stuckey T, Chieffo A, Colombo A, Shlofmitz R, Capodanno D, Dangas G, Pocock S, Mehran R. Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: primary results from the AVIATOR 2 international registry. EUROINTERVENTION 2022; 18:e656-e665. [PMID: 35656720 PMCID: PMC10241278 DOI: 10.4244/eij-d-21-01044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/06/2022] [Indexed: 10/09/2023]
Abstract
BACKGROUND Managing percutaneous coronary intervention (PCI) patients with atrial fibrillation (AF) presents challenges given that there are several potential antithrombotic therapy (ATT) strategies. AIMS We examined ATT patterns, agreement between subjective physician ratings and validated risk scores, physician-patient perceptions influencing ATT and 1-year outcomes. METHODS The AVIATOR 2 prospective registry enrolled 514 non-valvular AF-PCI patients from 11 sites. Treating physicians selected ATT and completed smartphone surveys rating stroke and bleeding risks, compared against CHA2DS2-VASc and HAS-BLED scores. Patients completed surveys regarding treatment understanding. Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, definite/probable stent thrombosis, stroke, target lesion revascularisation) and actionable bleeding (Bleeding Academic Research Consortium 2, 3 or 5). RESULTS The mean patient age was 73.2±9.0 years, including 25.8% females. Triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 66.5%, dual antiplatelet therapy (DAPT) in 20.7% and dual therapy (1 anticoagulant+1 antiplatelet agent) in 12.8% of patients. Physician ratings and validated risk scores showed poor agreement (stroke: kappa=0.03; bleeding: kappa=0.07). Physicians rated bleeding-related safety (93.8%) as the main factor affecting ATT choice. Patients worried about stroke over bleeding (50.6% vs 14.8%). No group differences by ATT strategy were observed in 1-year MACCE (TT 14.1% vs dual therapy 12.7% vs DAPT 18.5%; p=0.25), or actionable bleeding (14.7% vs 7.9% vs 15.1%, respectively; p=0.89). CONCLUSIONS The AVIATOR 2 study is the first digital health study examining physician-patient perspectives on ATT choices after AF-PCI. TT was the most common strategy without differences in 1-year outcomes in ATT strategy. Physicians rated safety first when prescribing ATT; patients feared stroke over bleeding. CLINICALTRIALS gov: NCT02362659.
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Affiliation(s)
- Jaya Chandrasekhar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Box Hill Hospital, Eastern Health Clinical School and Monash University, Melbourne, Australia
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Ridhima Goel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- State University of New York, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Johny Nicolas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clayton Snyder
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Kevin Marzo
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | | | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy and IRCCS Humanitas Research Hospital, Italy
| | | | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Kunadian V, Baber U, Pivato CA, Cao D, Dangas G, Sartori S, Zhang Z, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Dehghani P, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Džavík V, Gurbel P, Hamm CW, Henry T, Kastrati A, Marx SO, Oldroyd K, Steg PG, Pocock S, Mehran R. Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index. JACC Cardiovasc Interv 2022; 15:1948-1960. [DOI: 10.1016/j.jcin.2022.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
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14
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Sato T, Yamamoto K, Matsumura M, Moses J, Thomas S, Cohen D, Mintz G, Shlofmitz R, Jeremias A, Ali Z, Maehara A. TCT-285 Prevalence and Anatomical Factors to Be Associated With Stent Underexpansion in Non-Severely Calcified Lesions. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.335] [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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15
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Shlofmitz R, Klein A, Riley R, Price M, Saito S, Hill J, Rao S, Corley A. TCT-594 Impact of Arterial Access Site for Coronary Intravascular Lithotripsy Treatment of Severely Calcified Coronary Lesions: A Patient-Level Pooled Analysis of the Disrupt CAD III and CAD IV Studies. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.702] [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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16
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Sato T, Matsumura M, Yamamoto K, Moses J, Thomas S, Cohen D, Mintz G, Shlofmitz R, Ali Z, Maehara A. TCT-270 Impact of Eruptive- Versus Nodular-Calcified Nodule Morphology on Acute and Long-Term Outcomes After Stenting. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Spirito A, Cao D, Sartori S, Zhang Z, Nicolas J, Cohen D, Angiolillo D, Briguori C, Vogel B, Collier T, Dudek D, Escaned J, Sharma S, Farhan S, Huber K, Kastrati A, Kornowski R, Krucoff M, Kunadian V, Mehta S, Moliterno D, Ohman EM, Sardella G, Shlofmitz R, Steg P, Witzenbichler B, Han Y, Pocock S, Dangas G, Mehran R. TCT-13 Ticagrelor Monotherapy in Patients With Peripheral Artery Disease Undergoing PCI. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Shlofmitz E, Garcia-Garcia HM, Melaku G, Thomas S, Gallant M, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. Evaluation of the Reduction of Thrombus Burden With Cangrelor by OCT Assessment (REDUCE-CLOT) Study. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.160] [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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19
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Petrossian G, Ozdemir D, Galougahi KK, Scheiner J, Thomas SV, Shlofmitz R, Shlofmitz E, Jeremias A, Ali ZA. Role of Intracoronary Imaging in Acute Coronary Syndromes. US Cardiology Review 2022. [DOI: 10.15420/usc.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intravascular imaging with optical coherence tomography (OCT) and intravascular ultrasound provides superior visualization of the culprit plaques for acute coronary syndromes (ACS) compared with coronary angiography. Combined with angiography, intravascular imaging can be used to instigate ‘precision therapy’ for ACS. Post-mortem histopathology identified atherothrombosis at the exposed surface of a ruptured fibrous cap as the main cause of ACS. Further histopathological studies identified intact fibrous caps and calcified nodules as other culprit lesions for ACS. These plaque types were subsequently also identified on intravascular imaging, particularly with the high-resolution OCT. The less-common non-atherothrombotic causes of ACS are coronary artery spasm, coronary artery dissection, and coronary embolism. In this review, the authors provide an overview of clinical studies using intravascular imaging with OCT in the diagnosis and management of ACS.
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Affiliation(s)
| | - Denizhan Ozdemir
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Keyvan Karimi Galougahi
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Heart Research Institute, Sydney, Australia; DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Jonathan Scheiner
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Susan V Thomas
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Richard Shlofmitz
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Evan Shlofmitz
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY
| | - Allen Jeremias
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital – The Heart Center, Roslyn, NY; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [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: 11/07/2022] Open
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21
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Sattar Y, Almas T, Arshad J, Zghouzi M, Ullah W, Mir T, Mohamed MO, Elgendy IY, Aljaroudi W, Prasad A, Shlofmitz R, Mamas MA, Kereiakes DJ, Chadi Alraies M. Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis. IJC Heart & Vasculature 2022; 39:100975. [PMID: 35242998 PMCID: PMC8881660 DOI: 10.1016/j.ijcha.2022.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Background Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.
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22
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Dehghani P, Cao D, Baber U, Nicolas J, Sartori S, Pivato CA, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy after PCI in patients with concomitant diabetes mellitus and chronic kidney disease: TWILIGHT DM-CKD. Eur Heart J Cardiovasc Pharmacother 2022; 8:707-716. [PMID: 35325085 DOI: 10.1093/ehjcvp/pvac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Indexed: 11/14/2022]
Abstract
AIMS We aimed to evaluate the treatment effects of ticagrelor monotherapy in the very high-risk cohort of patients with concomitant diabetes mellitus (DM) and chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In the TWILIGHT trial, after 3-month dual antiplatelet therapy with ticagrelor and aspirin post-PCI, event-free patients were randomized to either aspirin or placebo in addition to ticagrelor for 12 months. Those with available information on DM and CKD status were included in this subanalysis and were stratified by the presence or absence of either condition: 3391 (54.1%) had neither DM nor CKD (DM-/CKD-), 1822 (29.0%) had DM only (DM+/CKD-), 561 (8.9%) had CKD only (DM-/CKD+), and 8.0% had both DM and CKD (DM+/CKD+). The incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding did not differ according to DM/CKD status (p-trend = 0.13), but there was a significant increase in BARC 3 or 5 bleeding (p-trend<0.001) as well as the key secondary endpoint of death, myocardial infarction, or stroke (p-trend<0.001). Ticagrelor plus placebo reduced bleeding events compared with ticagrelor plus aspirin across all four groups, including DM+/CKD+ patients with respect to BARC 2-5 (4.5% vs. 8.7%; HR 0.49, 95% CI 0.24-1.01) as well as BARC 3-5 (0.8% vs. 5.3%; HR 0.15, 95% CI 0.03-0.53) bleeding, with no evidence of heterogeneity. The risk of death, myocardial infarction, or stroke was similar between treatment arms across all groups. CONCLUSIONS Irrespective of the presence of DM, CKD, and their combination, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischemic events compared with ticagrelor plus aspirin.
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Affiliation(s)
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo A Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, NY, USA.,St. Francis Hospital, Roslyn, Roslyn, NY, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kurt Huber
- 3rd Dept Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, NY, USA
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dangas G, Baber U, Sharma S, Giustino G, Sartori S, Nicolas J, Goel R, Mehta S, Cohen D, Angiolillo DJ, Zhang Z, Camaj A, Cao D, Briguori C, Dudek D, Escaned J, Huber K, Collier T, Kornowski R, Kunadian V, Moliterno DJ, Ohman EM, Weisz G, Gil R, Krucoff MW, Kaul U, Oldroyd KG, Sardella G, Shlofmitz R, Witzenbichler B, Kastrati A, Han YL, Steg PG, Pocock S, Gibson CM, Mehran R. Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type: the TWILIGHT-STENT study. EUROINTERVENTION 2022; 17:1330-1339. [PMID: 34881696 PMCID: PMC9743248 DOI: 10.4244/eij-d-21-00721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/23/2022]
Abstract
BACKGROUND In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). AIMS The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type. METHODS In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation. RESULTS Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; pinteraction=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; pinteraction=0.60). In both unadjusted and covariate-adjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications. CONCLUSIONS As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
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Affiliation(s)
- George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shamir Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David Cohen
- St. Francis Hospital, Roslyn NY and Cardiovascular Research Foundation, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center, NY, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC, USA
| | - Upendra Kaul
- Batra Hospital and Medical Research Center, New Delhi, India
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | | | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Munchen, Munchen, Germany
| | - Ya-Ling Han
- Department of Cardiology, Shenyang North Hospital, Shenyang Shi, China
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Chiarito M, Baber U, Cao D, Sharma SK, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Dudek D, Džavík V, Escaned J, Gil R, Hamm CW, Henry T, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff M, Kunadian V, Mehta SR, Moliterno D, Ohman EM, Oldroyd K, Sardella G, Zhongjie Z, Sartori S, Stefanini G, Shlofmitz R, Steg PG, Weisz G, Witzenbichler B, Han YL, Pocock S, Gibson CM, Mehran R. Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy. JACC Cardiovasc Interv 2022; 15:282-293. [PMID: 35033468 DOI: 10.1016/j.jcin.2021.11.005] [Citation(s) in RCA: 2] [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: 09/22/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate if patients with prior myocardial infarction (MI) could benefit from ticagrelor monotherapy in terms of bleeding reduction without any compromise in ischemic event prevention. BACKGROUND Patients with history of MI who undergo percutaneous coronary intervention (PCI) remain at risk for recurrent ischemic events. The optimal antithrombotic strategy for this cohort remains debated. METHODS In this prespecified analysis of the randomized TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, the authors evaluated the impact of history of MI on treatment effect of ticagrelor monotherapy versus ticagrelor plus aspirin in patients undergoing PCI with drug-eluting stent with at least 1 clinical and 1 angiographic high-risk feature and free from adverse events at 3 months after index PCI. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, and the key secondary endpoint was the composite of all-cause death, MI, or stroke, both at 12 months after randomization. RESULTS A total of 1,937 patients (29.7%) with and 4,595 patients (70.3%) without prior MI were randomized to ticagrelor and placebo or ticagrelor and aspirin. At 1 year after randomization, patients with prior MI experienced higher rates of death, MI, or stroke (5.7% vs 3.2%; P < 0.001) but similar BARC types 2 to 5 bleeding (5.0% vs 5.5%; P = 0.677) compared with patients without prior MI. Ticagrelor monotherapy consistently reduced the risk for the primary bleeding outcome in patients with (3.4% vs 6.7%; HR: 0.50; 95% CI: 0.33-0.76) and without (4.2% vs 7.0%; HR: 0.58; 95% CI: 0.45-0.76; Pinteraction = 0.54) prior MI. Rates of the key secondary ischemic outcome were not significantly different between treatment groups irrespective of history of MI (prior MI, 6.0% vs 5.5% [HR: 1.09; 95% CI: 0.75-1.58]; no prior MI, 3.1% vs 3.3% [HR: 0.92; 95% CI: 0.67-1.28]; Pinteraction = 0.52). CONCLUSIONS Ticagrelor monotherapy is associated with significantly lower risk for bleeding events compared with ticagrelor plus aspirin, without any compromise in ischemic prevention, among high-risk patients with history of MI undergoing PCI. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242).
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Affiliation(s)
- Mauro Chiarito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Usman Baber
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, USA
| | - Dariusz Dudek
- 2nd Department of Cardiology Jagiellonian University Medical College, Krakow, Poland
| | - Vladimír Džavík
- Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Javier Escaned
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid, Spain
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | | | - Timothy Henry
- Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, Ohio, USA
| | | | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Keith Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Zhang Zhongjie
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | | | - Giora Weisz
- Montefiore Medical Center, New York, New York, USA
| | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Shlofmitz E, Garcia-Garcia HM, Melaku G, Thomas S, Gallant M, Busch J, Ali ZA, Jeremias A, Shlofmitz R, Waksman R. CRT-400.10 Evaluation of the Reduction of Thrombus Burden With Cangrelor by OCT Assessment (REDUCE-CLOT) Study. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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McGuire C, Shlofmitz E, D. Melaku G, O. Kuku K, Kahsay Y, Shlofmitz R, Jeremias y A, Garcia-Garcia HM. Comparaci�n de par�metros cuantitativos de calcio por tomograf�a de coherencia �ptica y angiograf�a coronaria invasiva. RECIC 2022. [DOI: 10.24875/recic.m21000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Escaned J, Cao D, Baber U, Nicolas J, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta S, Moliterno DJ, Ohman EM, Oldroyd KG, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR. Eur Heart J 2021; 42:4624-4634. [PMID: 34662382 DOI: 10.1093/eurheartj/ehab702] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 07/20/2021] [Revised: 08/08/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Patients at high bleeding risk (HBR) represent a prevalent subgroup among those undergoing percutaneous coronary intervention (PCI). Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy. The aim of this study was to assess the effects of ticagrelor monotherapy after 3-month DAPT in a contemporary HBR population. METHODS AND RESULTS This prespecified analysis of the TWILIGHT trial evaluated the treatment effects of early aspirin withdrawal followed by ticagrelor monotherapy in HBR patients undergoing PCI with drug-eluting stents. After 3 months of ticagrelor plus aspirin, event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor. A total of 1064 (17.2%) met the Academic Research Consortium definition for HBR. Ticagrelor monotherapy reduced the incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding compared with ticagrelor plus aspirin in HBR (6.3% vs. 11.4%; hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.35-0.82) and non-HBR patients (3.5% vs. 5.9%; HR 0.59, 95% CI 0.46-0.77) with similar relative (Pinteraction = 0.67) but a trend towards greater absolute risk reduction in the former [-5.1% vs. -2.3%; difference in absolute risk differences (ARDs) -2.8%, 95% CI -6.4% to 0.8%, P = 0.130]. A similar pattern was observed for more severe BARC 3 or 5 bleeding with a larger absolute risk reduction in HBR patients (-3.5% vs. -0.5%; difference in ARDs -3.0%, 95% CI -5.2% to -0.8%, P = 0.008). There was no significant difference in the key secondary endpoint of death, myocardial infarction, or stroke between treatment arms, irrespective of HBR status. CONCLUSIONS Among HBR patients undergoing PCI who completed 3-month DAPT without experiencing major adverse events, aspirin discontinuation followed by ticagrelor monotherapy significantly reduced bleeding without increasing ischaemic events, compared with ticagrelor plus aspirin. The absolute risk reduction in major bleeding was larger in HBR than non-HBR patients.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid 28040, Spain
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw 02-507, Poland
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Sigmund Freud University, Medical Faculty, Vienna 1160, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Richard Shlofmitz
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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Angiolillo D, Pivato CA, Cao D, Kunadian V, Sartori S, Zhang Z, Cohen D, Collier T, Dudek D, Gil R, Huber K, Kornowski R, Mehta S, Ohman EM, Oldroyd K, Sardella G, Sharma S, Shlofmitz R, Weisz G, Witzenbichler B, Dangas G, Pocock S, Mehran R. TCT-217 Predictors of Dyspnea in Patients Receiving Ticagrelor After PCI: Insights From the Twilight Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beerkens F, Cao D, Dangas G, Sartori S, Zhang Z, Nicolas J, Camaj A, Claessen B, Pivato CA, Power D, Razuk V, Jones D, Angiolillo D, Mehta S, Gibson CM, Sardella G, Sharma S, Shlofmitz R, Collier T, Pocock S, Mehran R. TCT-38 Ticagrelor With and Without Aspirin in Patients With Previous Coronary Artery Bypass Graft Undergoing Percutaneous Coronary Intervention: The TWILIGHT-CABG Subanalysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lundy E, Shlofmitz E, Jeremias A, Abou-Eid G, Porter C, Thomas S, Maehara A, Pappas T, Mei N, Scheiner J, Robinson N, Ali Z, Shlofmitz R. TCT-307 Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shlofmitz E, Matsumura M, Maehara A, Moses J, Petrossian G, Abittan M, Kirtane A, Berke A, Pappas T, Chung W, Porter C, Thomas S, Glodan C, Ben-Yehuda O, Cohen D, Kereiakes D, Shlofmitz R, Ali Z, Jeremias A. TCT-273 Impact of Shockwave Intravascular Lithotripsy Induced Calcium Fracture for Treatment of Stent Underexpansion Mediated In-Stent Restenosis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ali Z, Hill J, Saito S, Gonzalo N, Di Mario C, Riley R, Honton B, Maehara A, Matsumura M, Kereiakes D, Stone G, Shlofmitz R. TCT-120 Optical Coherence Tomography Characterization of Shockwave Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions: Patient-Level Pooled Analysis of the Disrupt CAD OCT Substudies. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cao D, Baber U, Dangas G, Sartori S, Zhongjie Z, Giustino G, Angiolillo DJ, Mehta S, Gibson CM, Sardella G, Sharma SK, Shlofmitz R, Collier T, Pocock S, Mehran R. Ticagrelor monotherapy after percutaneous coronary intervention in patients with concomitant diabetes mellitus and chronic kidney disease: a TWILIGHT substudy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2117] [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
Diabetes mellitus (DM) and chronic kidney disease (CKD) are established risk factors for cardiovascular events, with patients presenting both conditions being at extremely high risk. P2Y12 inhibitor monotherapy with ticagrelor after a short course of dual antiplatelet therapy has emerged as a bleeding avoidance strategy for high-risk patients undergoing percutaneous coronary intervention (PCI).
Purpose
To investigate ischemic and bleeding outcomes associated with ticagrelor monotherapy versus ticagrelor plus aspirin according to the presence or absence of CKD and DM.
Methods
The TWILIGHT trial enrolled patients undergoing PCI with a drug-eluting stent who fulfilled at least one clinical and one angiographic high-risk criterion. Both DM and CKD (estimated glomerular filtration rate <60 mL/min/1.73m2) were clinical study entry criteria. Following 3 months of ticagrelor plus aspirin, patients who had been adherent to treatment and free from major adverse events were randomly assigned to either aspirin or placebo in addition to ticagrelor for 1 year. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. Net adverse clinical events (NACE) were defined as BARC type 3 or 5 bleeding, all-cause death, myocardial infarction, or stroke.
Results
Of the 6273 patients included in the analysis, 8.0% had both CKD and DM (DM+/CKD+), 8.9% had CKD only (DM-/CKD+), 29.0% had DM only (DM+/CKD-), and 52.1% had neither CKD nor DM (DM-/CKD-). At 1-year follow-up, there was a progressive increase in the rates of bleeding and ischemic events according to DM and CKD status (Figure 1). Ticagrelor plus placebo reduced the primary bleeding endpoint as compared with ticagrelor plus aspirin across all study groups, including DM+/CKD+ patients (4.7% vs. 8.7%; HR 0.52, 95% CI 0.25–1.07), with no evidence of heterogeneity (p-interaction=0.68). Similar treatment effects of ticagrelor monotherapy were observed for major BARC type 3 or 5 bleeding (p-interaction=0.17), with DM+/CKD+ patients showing the greatest absolute risk reduction (0.9% vs. 5.1%; HR 0.16, 95% CI 0.04–0.72). The key secondary endpoint was not significantly different between treatment arms across study groups, with the exception of a reduced risk in DM+/CKD- patients receiving ticagrelor monotherapy (p-interaction=0.033). A similar pattern in the DM+/CKD- group was observed for NACE (p-interaction=0.030) (Figure 2).
Conclusions
Among high-risk patients undergoing PCI, ticagrelor monotherapy reduced the risk of clinically relevant and major bleeding without a significant increase in ischemic events as compared with ticagrelor plus aspirin, irrespective of the presence of DM and CKD. Furthermore, ticagrelor monotherapy seemed to be associated with a more favourable net benefit in patients with DM without CKD.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-initiated grant from AstraZeneca Figure 1. Event rates according to DM/CKD statusFigure 2. Effects of ticagrelor monotherapy
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Affiliation(s)
- D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Z Zhongjie
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Giustino
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | - S Mehta
- McMaster University, Hamilton, Canada
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | - G Sardella
- Umberto I Polyclinic of Rome, Rome, Italy
| | - S K Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Shlofmitz
- St. Francis Hospital, Roslyn, United States of America
| | - T Collier
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Stefanini GG, Briguori C, Cao D, Baber U, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Mehta S, Cohen DJ, Collier T, Dudek D, Escaned J, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Oldroyd KG, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Ticagrelor monotherapy in patients with chronic kidney disease undergoing percutaneous coronary intervention: TWILIGHT-CKD. Eur Heart J 2021; 42:4683-4693. [PMID: 34423374 DOI: 10.1093/eurheartj/ehab533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to assess the impact of chronic kidney disease (CKD) on the safety and efficacy of ticagrelor monotherapy among patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In this prespecified subanalysis of the TWILIGHT trial, we evaluated the treatment effects of ticagrelor with or without aspirin according to renal function. The trial enrolled patients undergoing drug-eluting stent implantation who fulfilled at least one clinical and one angiographic high-risk criterion. Chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, was a clinical study entry criterion. Following a 3-month period of ticagrelor plus aspirin, event-free patients were randomly assigned to aspirin or placebo on top of ticagrelor for an additional 12 months. Of the 6835 patients randomized and with available eGFR at baseline, 1111 (16.3%) had CKD. Ticagrelor plus placebo reduced the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding as compared with ticagrelor plus aspirin in both patients with [4.6% vs. 9.0%; hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31-0.80] and without (4.0% vs. 6.7%; HR 0.59, 95% CI 0.47-0.75; Pinteraction = 0.508) CKD, but the absolute risk reduction was greater in the former group. Rates of death, myocardial infarction, or stroke were not significantly different between the two randomized groups irrespective of the presence (7.9% vs. 5.7%; HR 1.40, 95% CI 0.88-2.22) or absence of (3.2% vs. 3.6%; HR 0.90, 95% CI 0.68-1.20; Pinteraction = 0.111) CKD. CONCLUSION Among CKD patients undergoing PCI, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischaemic events as compared with ticagrelor plus aspirin.
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Affiliation(s)
- Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20090, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | | | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Usman Baber
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA.,St. Francis Hospital, Roslyn, NY 11576, USA
| | - Timothy Collier
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid 28040, Spain
| | | | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw 02-507, Poland
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith G Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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Valgimigli M, Mehran R, Franzone A, da Costa BR, Baber U, Piccolo R, McFadden EP, Vranckx P, Angiolillo DJ, Leonardi S, Cao D, Dangas GD, Mehta SR, Serruys PW, Gibson CM, Steg GP, Sharma SK, Hamm C, Shlofmitz R, Liebetrau C, Briguori C, Janssens L, Huber K, Ferrario M, Kunadian V, Cohen DJ, Zurakowski A, Oldroyd KG, Yaling H, Dudek D, Sartori S, Kirkham B, Escaned J, Heg D, Windecker S, Pocock S, Jüni P. Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC Cardiovasc Interv 2021; 14:444-456. [PMID: 33602441 DOI: 10.1016/j.jcin.2020.11.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/04/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents. BACKGROUND The role of abbreviated DAPT followed by an oral P2Y12 inhibitor after PCI remains uncertain. METHODS Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale. RESULTS Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar. CONCLUSIONS Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.
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Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno R da Costa
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Eùgene P McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands; Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shamir R Mehta
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gabriel P Steg
- Université de Paris and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian Hamm
- German Center for Cardiovascular Research, partner site RheinMain, Frankfurt am Main, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Christoph Liebetrau
- German Center for Cardiovascular Research, partner site RheinMain, Frankfurt am Main, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | | | | | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University Medical School, Vienna, Austria
| | - Maurizio Ferrario
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Cohen
- Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Aleksander Zurakowski
- Department of Interventional Cardiology Chrzanów, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Keith G Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Han Yaling
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Dariuz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Kirkham
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | - Dik Heg
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Jüni
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Kobayashi Y, Collet C, Achenbach S, Engstrøm T, Assali A, Shlofmitz R, Fournier S, Kirtane AJ, Ali ZA, Kornowski R, Leon MB, De Bruyne B, Fearon W. Diagnostic performance of angiography-based fractional flow reserve by patient and lesion characteristics. EUROINTERVENTION 2021; 17:e294-e300. [PMID: 32364503 PMCID: PMC9724905 DOI: 10.4244/eij-d-19-00933] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A large, prospective, multicentre trial recently showed that fractional flow reserve (FFR) derived from coronary angiography (FFRangio) has an accuracy of 92% compared with conventional guidewire-based FFR (FFRwire); however, little is known about whether specific patient/lesion characteristics affect the diagnostic performance. AIMS The primary goal of the present study was to investigate whether specific patient or lesion characteristics such as high body mass index (BMI), presentation with an acute coronary syndrome, or lesion location affect the diagnostic performance of FFRangio in patients enrolled in the FAST-FFR study. METHODS FFRangio was measured in a blinded fashion in 301 patients (319 vessels) who were undergoing FFRwire assessment. Using an FFRwire ≤0.80 as a reference, the diagnostic performance of FFRangio was compared in pre-specified subgroups. RESULTS The mean FFRwire and FFRangio were 0.81±0.13 and 0.80±0.12. Overall, FFRangio had a sensitivity of 93.5% and specificity of 91.2% for predicting FFRwire. Patient characteristics including age, sex, clinical presentation, body mass index, and diabetes did not affect sensitivity or specificity (p>0.05 for all). Similarly, lesion characteristics including calcification and tortuosity did not affect sensitivity or specificity (p>0.05 for all), nor did lesion location (proximal, middle, versus distal). Sensitivity was equally high across all target vessels, while specificity was highest in the LAD and lower (~85%) in the RCA and LCx (p<0.05). CONCLUSIONS FFRangio derived from coronary angiography has a high diagnostic performance regardless of patient and most lesion characteristics. The interaction of vessel on the specificity will need to be confirmed in larger cohorts.
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Affiliation(s)
- Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, H2103, Stanford, CA 94305-5218, USA
| | - Carlos Collet
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Engstrøm
- The Heart Center, Rigs Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Abid Assali
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | | | - Stephane Fournier
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium
| | - Ajay J. Kirtane
- Columbia University Medical Center, New York, NY and Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A. Ali
- Columbia University Medical Center, New York, NY and Cardiovascular Research Foundation, New York, NY, USA
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Martin B. Leon
- Columbia University Medical Center, New York, NY and Cardiovascular Research Foundation, New York, NY, USA
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium
| | - William Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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Angiolillo DJ, Cao D, Baber U, Sartori S, Zhang Z, Dangas G, Mehta S, Briguori C, Cohen DJ, Collier T, Dudek D, Escaned J, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Moliterno DJ, Ohman EM, Oldroyd K, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Pocock S, Mehran R. Impact of Age on the Safety and Efficacy of Ticagrelor Monotherapy in Patients Undergoing PCI. JACC Cardiovasc Interv 2021; 14:1434-1446. [PMID: 34238553 DOI: 10.1016/j.jcin.2021.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact of age on the safety and efficacy of ticagrelor monotherapy after percutaneous coronary intervention (PCI). BACKGROUND As the risk for bleeding and ischemic complications after PCI increases with age, the authors conducted a pre-specified analysis of the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial to evaluate the possible benefits of ticagrelor monotherapy according to age. METHODS The TWILIGHT trial enrolled patients undergoing PCI with drug-eluting stents who fulfilled at least 1 clinical and 1 angiographic high-risk criterion. Age ≥65 years was a clinical entry criterion. After 3 months of dual-antiplatelet therapy with ticagrelor, event-free patients were randomized to ticagrelor plus placebo or ticagrelor plus aspirin for an additional 12 months. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. RESULTS A total of 3,113 patients (47.7%) were ≥65 years of age. At 1 year after randomization, ticagrelor monotherapy significantly reduced BARC type 2, 3, or 5 bleeding (4.5% vs. 8.2%; hazard ratio: 0.53; 95% confidence interval: 0.40 to 0.71) without increasing ischemic events (4.2% vs. 4.4%; hazard ratio: 0.96; 95% confidence interval: 0.68 to 1.35) compared with ticagrelor plus aspirin among patients ≥65 years of age. These findings were consistent in patients <65 years of age with respect to the primary (pinteraction = 0.62) and key secondary (pinteraction = 0.77) endpoints and across different age categories. CONCLUSIONS A strategy of ticagrelor monotherapy following 3 months of dual-antiplatelet therapy significantly reduced clinically relevant bleeding compared with ticagrelor plus aspirin without an increase in ischemic events, irrespective of age.
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Affiliation(s)
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Usman Baber
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Timothy Collier
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Keith Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | | | - Giora Weisz
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, USA
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA.
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Ali Z, Karimi Galougahi K, Mintz GS, Maehara A, Shlofmitz R, Mattesini A. Intracoronary optical coherence tomography: state of the art and future directions. EUROINTERVENTION 2021; 17:e105-e123. [PMID: 34110288 PMCID: PMC9725016 DOI: 10.4244/eij-d-21-00089] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts, and an algorithmic approach for using OCT in PCI guidance. We discuss the utility of OCT in acute coronary syndromes, provide a summary of the clinical trial data, list the work in progress, and discuss the future directions.
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Affiliation(s)
- Ziad Ali
- St. Francis Hospital and Heart Center 100 Port Washington Blvd., Roslyn, NY 11576, USA
| | | | - Gary S. Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Richard Shlofmitz
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Alessio Mattesini
- Structural Interventional Cardiology Unit, Careggi University Hospital, Florence, Italy
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Riley RF, Kereiakes D, Mario CD, Fajadet J, Shlofmitz R, Saito S, Ali Z, Klein A, Price M, Stone G, Hill J. INTRAVASCULAR LITHOTRIPSY FOR THE TREATMENT OF SEVERELY CALCIFIED CORONARY LESIONS - A PATIENT LEVEL POOLED ANALYSIS OF THE DISRUPT CAD I, II, III AND IV STUDIES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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40
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Seike F, Usui E, Matsumura M, Jeremias A, Shlofmitz E, Ali Z, Nguyen J, Porter C, Cao J, Pappas T, Petrossian G, Moses J, Yasuda K, Mintz G, Shlofmitz R, Maehara A. INTRACORONARY OPTICAL COHERENCE TOMOGRAPHY-DERIVED VIRTUAL FRACTIONAL FLOW RESERVE TO PREDICT POST-PCI OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Ali Z, Karimi Galougahi K, Maehara A, Shlofmitz R, Fabbiocchi F, Guagliumi G, Alfonso F, Akasaka T, Matsumura M, Mintz G, Ben-Yehuda O, Zhang Z, Rapoza R, West N, Stone G. Outcomes of optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation: one-year results from the ILUMIEN III: OPTIMIZE PCI trial. EUROINTERVENTION 2021; 16:1085-1091. [PMID: 32540793 PMCID: PMC9724851 DOI: 10.4244/eij-d-20-00498] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 11/23/2022]
Abstract
AIMS In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact on clinical outcomes is unknown. The aim of the present study was to report the 12-month clinical follow-up data from the ILUMIEN III study. METHODS AND RESULTS OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months were adjudicated by a blinded clinical events committee. There were no significant differences in the rates of TLF (2.0% OCT, 3.7% IVUS, 1.4% angiography), MACE (9.8% OCT, 9.1% IVUS, 7.9% angiography), or any of the individual components of these outcomes among the groups. No independent predictors of 12-month stent-related clinical events were identified from final OCT. CONCLUSIONS In this underpowered study, OCT-guided PCI of non-complex lesions did not show a statistical difference in clinical outcomes at 12 months compared with IVUS or angiography guidance. An appropriately powered trial, including only complex patients and lesions, is underway to substantiate the potential clinical benefit of OCT-guided PCI. TRIAL REGISTRATION NCT02471586.
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Affiliation(s)
- Ziad Ali
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA. E-mail:
| | | | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Madrid, Spain
| | | | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gary Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Nick West
- Abbott Vascular, Santa Clara, CA, USA
| | - Gregg Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ali Z, Landmesser U, Karimi Galougahi K, Maehara A, Matsumura M, Shlofmitz R, Guagliumi G, Price M, Hill J, Akasaka T, Prati F, Bezerra H, Wijns W, Mintz G, Ben-Yehuda O, McGreevy R, Zhang Z, Rapoza R, West N, Stone G. Optical coherence tomography-guided coronary stent implantation compared to angiography: a multicentre randomised trial in PCI - design and rationale of ILUMIEN IV: OPTIMAL PCI. EUROINTERVENTION 2021; 16:1092-1099. [PMID: 32863246 PMCID: PMC9725042 DOI: 10.4244/eij-d-20-00501] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 11/23/2022]
Abstract
AIMS Randomised trials have demonstrated improvement in clinical outcomes with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III trial demonstrated non-inferiority of an optical coherence tomography (OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen dimensions. ILUMIEN IV is a large-scale, multicentre, randomised trial designed to demonstrate the superiority of OCT- versus angiography-guided stent implantation in patients with high-risk clinical characteristics (diabetes) and/or complex angiographic lesions in achieving larger post-PCI lumen dimensions and improving clinical outcomes. METHODS AND RESULTS ILUMIEN IV is a prospective, single-blind clinical investigation that will randomise between 2,490 and 3,656 patients using an adaptive design to OCT-guided versus angiography-guided coronary stent implantation in a 1:1 ratio. The primary endpoints are: (1) post-PCI minimal stent area assessed by OCT in each randomised arm, and (2) target vessel failure, the composite of cardiac death, target vessel myocardial infarction, or ischaemia-driven target vessel revascularisation. Clinical follow-up will continue for up to two years. The trial is currently enrolling, and the principal results are expected in 2022. CONCLUSIONS The large-scale ILUMIEN IV randomised controlled trial will evaluate the effectiveness of OCT-guided versus angiography-guided PCI in improving post-PCI lumen dimensions and clinical outcomes in patients with diabetes and/or with complex coronary lesions. TRIAL REGISTRATION NCT03507777.
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Affiliation(s)
- Ziad Ali
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA. E-mail:
| | - Ulf Landmesser
- Department of Cardiology, Charité-University Medicine Berlin, Berlin, Germany,Berlin Institute of Health, Berlin, Germany,German Centre for Cardiovascular Research, Berlin, Germany
| | - Keyvan Karimi Galougahi
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Matthew Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | | | | | | | - Hiram Bezerra
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - William Wijns
- The Lambe Institute for Translational Research, NUI Galway, Galway, Ireland,Saolta University Healthcare Group, Galway, Ireland
| | - Gary Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Nick West
- Abbott Vascular, Santa Clara, CA, USA
| | - Gregg Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Despite consistent clinical data supporting the use of intravascular imaging with percutaneous coronary intervention, utilization remains low. A practical and standardized approach to incorporating intravascular imaging with percutaneous coronary intervention may overcome the barriers to utilization. This review focuses on basic image interpretation with intravascular ultrasound and optical coherence tomography and proposes an algorithmic approach to stent sizing and optimization. Incorporation of this strategic method for percutaneous coronary intervention may aid in the greater adoption of intravascular imaging for percutaneous coronary intervention.
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Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Ziad A. Ali
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Richard Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
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Lee MS, Wadia SK, Shlofmitz R. Impact of Sex on Outcomes Among Patients With Cardiac Allograft Vasculopathy Who Undergo Percutaneous Coronary Intervention. J Invasive Cardiol 2020; 32:453-458. [PMID: 33221733] [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: 06/11/2023]
Abstract
BACKGROUND Orthotopic heart transplantation (OHT) is a reasonable treatment strategy for patients with endstage heart failure. Percutaneous coronary intervention (PCI) can be performed to treat cardiac allograft vasculopathy (CAV). We sought to examine sex-based differences and outcomes in patients undergoing PCI for CAV. METHODS This was a single- center, retrospective study of consecutive patients undergoing PCI for CAV from July 1993 to July 2017. The primary outcome was a composite of death, myocardial infarction (MI), target-vessel revascularization (TVR), or repeat OHT. RESULTS A total of 140 patients (39% women) who underwent PCI for CAV were studied over a median follow-up of 3.9 years. Women were more likely to be younger and had less hypertension, with a trend toward less diabetes and higher ejection fractions. No significant differences in the primary composite outcome were noted between women and men (hazard ratio, 1.16; 95% confidence interval, 0.76-1.76; P=.49), as well as the individual outcomes of death, MI, or TVR (P>.05 for all). Women were more likely to undergo repeat OHT than men (hazard ratio, 2.93; 95% confidence interval, 1.48-5.81; P<.01). After covariate adjustment, female sex and younger age were independently associated with repeat OHT for CAV (P<.05). No differences in the primary outcome as well as the individual outcomes of death, MI, or TVR were noted between sex groups in patients who underwent PCI for CAV. CONCLUSION Female patients were more likely to undergo redo OHT for CAV. Younger age at time of initial OHT was associated with a need for repeat OHT.
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Affiliation(s)
- Michael S Lee
- UCLA Medical Center, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095.
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45
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Baber U, Dangas G, Angiolillo DJ, Cohen DJ, Sharma SK, Nicolas J, Briguori C, Cha JY, Collier T, Dudek D, Džavik V, Escaned J, Gil R, Gurbel P, Hamm CW, Henry T, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff M, Kunadian V, Marx SO, Mehta S, Moliterno D, Ohman EM, Oldroyd K, Sardella G, Sartori S, Shlofmitz R, Steg PG, Weisz G, Witzenbichler B, Han YL, Pocock S, Gibson CM, Mehran R. Ticagrelor alone vs. ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS. Eur Heart J 2020; 41:3533-3545. [DOI: 10.1093/eurheartj/ehaa670] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/08/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
AbstractAims The aim of this study was to determine the effect of ticagrelor monotherapy on clinically relevant bleeding and major ischaemic events in relation to clinical presentation with and without non-ST elevation acute coronary syndromes (NSTE-ACS) among patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods and results We conducted a pre-specified subgroup analysis of The Ticagrelor With Aspirin or Alone in High Risk Patients After Coronary Intervention (TWILIGHT) trial, which enrolled 9006 patients with high-risk features undergoing PCI with DES. After 3 months of dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin, 7119 adherent and event-free patients were randomized in a double-blind manner to ticagrelor plus placebo versus ticagrelor plus aspirin for 12 months. The primary outcome was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding while the composite of all-cause death, myocardial infarction (MI), or stroke was the key secondary outcome. Among patients with NSTE-ACS (n = 4614), ticagrelor monotherapy reduced BARC 2, 3, or 5 bleeding by 53% [3.6% vs. 7.6%; hazard ratio (HR) 0.47; 95% confidence interval (CI) 0.36–0.61; P < 0.001) and in stable patients (n = 2503) by 24% (4.8% vs. 6.2%; HR 0.76; 95% CI 0.54–1.06; P = 0.11; nominal Pint = 0.03). Rates of all-cause death, MI, or stroke among those with (4.3% vs. 4.4%; HR 0.97; 95% CI 0.74–1.28; P = 0.84) and without (3.1% vs. 3.2%; HR 0.96; 95% CI 0.61–1.49; P = 0.85) NSTE-ACS were similar between treatment arms irrespective of clinical presentation (Pint = 0.96).Conclusion Among patients with or without NSTE-ACS who have completed an initial 3-month course of DAPT following PCI with DES, ticagrelor monotherapy reduced clinically meaningful bleeding events without increasing ischaemic risk as compared with ticagrelor plus aspirin. The benefits of ticagrelor monotherapy with respect to bleeding events were more pronounced in patients with NSTE-ACS.Trial registrationClinicaltrials.gov identifier: NCT02270242.
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Affiliation(s)
- Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - George Dangas
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | | | - David Joel Cohen
- Department of Cardiology, University of Missouri-Kansas CIty, Kansas City, MO 64110, USA
| | - Samin Kumar Sharma
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Johny Nicolas
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, 80122 Napoli NA, Italy
| | - Jin Yu Cha
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Timothy Collier
- Department of Cardiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Dariusz Dudek
- The 2nd Department of Cardiology Jagiellonian University Medical College, Swietej Anny 12, 31-008 Krakow, Poland
| | - Vladimir Džavik
- Department of Interventional Cardiology, Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2CA, Canada
| | - Javier Escaned
- Department of Cardiology, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Calle del Prof Martin Lagos, s/n, 28040 Madrid, Spain
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 137 Woloska Str, 02-507 Warsaw, Poland
| | - Paul Gurbel
- Department of Cardiology, Sinai Hospital of Baltimore System, Baltimore, MD 21215, USA
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Clinic, Benekestrabe 2-8, 61231 Bad Nauheim, Germany
| | - Timothy Henry
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH 45219, USA
| | - Kurt Huber
- Department of Cardiology, Wilhelminenhospital, Montleartstrabe 37, 1160 Wien, Austria
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Munchen, Lazarettstrabe 36, 80636 Munchen, Germany
| | - Upendra Kaul
- Department of Cardiology, Batra Hospital and Medical Research Centre, New Delhi 110062, India
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petach Tikva 49100, Israel
| | - Mitchell Krucoff
- Department of Cardiology, Duke University Medical Center–Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Vijay Kunadian
- Department of Cardiology, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Freeman Road, High Heaton, NE7 7DN Newcastle upon Tyne, UK
- Department of Cardiology, Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Road, High Heaton, NE7 7DN Newcastle upon Tyne, UK
| | - Steven Owen Marx
- Department of Cardiology, Columbia University Medical Center, New York, NY 10027, USA
| | - Shamir Mehta
- Department of Cardiology, Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - David Moliterno
- Department of Cardiology, University of Kentucky, Lexington, KY 40506, USA
| | - Erik Magnus Ohman
- Department of Cardiology, Duke University Medical Center–Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Keith Oldroyd
- Department of Cardiology, The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Agamemnon St, Clydebank G81 4DY, UK
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I University, 00161 Roma, Italy
| | - Samantha Sartori
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, 100 Port Washington Blvd, Roslyn, NY 11576, USA
| | - Philippe Gabriel Steg
- Department of Cardiology, Groupe Hospitalier Bichat–Claude-Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center, The Bronx, NY 10467, USA
| | - Bernhard Witzenbichler
- Department of Cardiology, Helios Amper-Klinikum, Krankenhausstrabe 15, 85221 Dachau, Germany
| | - Ya-Ling Han
- Department of Cardiology, Shenyang North Hospital, Huanggu Qu, Shenyang Shi, Liaoning Sheng, China
| | - Stuart Pocock
- Department of Cardiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | | | - Roxana Mehran
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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Shlofmitz R, Riley R, Waksman R, Oldroyd K, Stone G, Hill J, Maehara A, Kereiakes D. TCT CONNECT-404 Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Stenoses: Results From the Disrupt CAD III Optical Coherence Tomography Sub-study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.427] [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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Dangas G, Baber U, Sharma S, Giustino G, Mehta S, Cohen DJ, Angiolillo DJ, Sartori S, Chandiramani R, Briguori C, Dudek D, Escaned J, Huber K, Collier T, Kornowski R, Kunadian V, Kaul U, Oldroyd K, Sardella G, Shlofmitz R, Witzenbichler B, Ya-Ling H, Pocock S, Gibson CM, Mehran R. Ticagrelor With or Without Aspirin After Complex PCI. J Am Coll Cardiol 2020; 75:2414-2424. [DOI: 10.1016/j.jacc.2020.03.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
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Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, Cha JY, Collier T, Dangas G, Dudek D, Džavík V, Escaned J, Gil R, Gurbel P, Hamm CW, Henry T, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff M, Kunadian V, Marx SO, Mehta SR, Moliterno D, Ohman EM, Oldroyd K, Sardella G, Sartori S, Shlofmitz R, Steg PG, Weisz G, Witzenbichler B, Han YL, Pocock S, Gibson CM. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019; 381:2032-2042. [PMID: 31556978 DOI: 10.1056/nejmoa1908419] [Citation(s) in RCA: 580] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI). METHODS In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin of 1.6 percentage points. RESULTS We enrolled 9006 patients, and 7119 underwent randomization after 3 months. Between randomization and 1 year, the incidence of the primary end point was 4.0% among patients randomly assigned to receive ticagrelor plus placebo and 7.1% among patients assigned to receive ticagrelor plus aspirin (hazard ratio, 0.56; 95% confidence interval [CI], 0.45 to 0.68; P<0.001). The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, -0.06 percentage points; 95% CI, -0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority). CONCLUSIONS Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke. (Funded by AstraZeneca; TWILIGHT ClinicalTrials.gov number, NCT02270242.).
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Affiliation(s)
- Roxana Mehran
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Usman Baber
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Samin K Sharma
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - David J Cohen
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Dominick J Angiolillo
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Carlo Briguori
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Jin Y Cha
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Timothy Collier
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - George Dangas
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Dariusz Dudek
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Vladimír Džavík
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Javier Escaned
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Robert Gil
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Paul Gurbel
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Christian W Hamm
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Timothy Henry
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Kurt Huber
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Adnan Kastrati
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Upendra Kaul
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Ran Kornowski
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Mitchell Krucoff
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Vijay Kunadian
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Steven O Marx
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Shamir R Mehta
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - David Moliterno
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - E Magnus Ohman
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Keith Oldroyd
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Gennaro Sardella
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Samantha Sartori
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Richard Shlofmitz
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - P Gabriel Steg
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Giora Weisz
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Bernhard Witzenbichler
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Ya-Ling Han
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - Stuart Pocock
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
| | - C Michael Gibson
- From the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital (R.M., U.B., J.Y.C., G.D., S.S.), Mount Sinai Health System (S.K.S.), Columbia University Medical Center (S.O.M.), Icahn School of Medicine at Mount Sinai (S.S.), and Montefiore Medical Center (G.W.), New York, and St. Francis Hospital, Roslyn (R.S.) - all in New York; Kansas City, Missouri (D.J.C.); the University of Florida-Shands, Jacksonville (D.J.A.); Clinica Mediterranea, Naples (C.B.), and Policlinico Umberto I University, Rome (G.S.) - both in Italy; the London School of Hygiene and Tropical Medicine, London (T.C., S.P.), Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (V.K.), and the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; the 2nd Department of Cardiology Jagiellonian University Medical College, Krakow (D.D.), and the Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw (R.G.) - both in Poland; Research and Innovation in Interventional Cardiology and Cardiac Intensive Care, Peter Munk Cardiac Centre, University Health Network, Toronto (V.D.), and Hamilton Health Sciences, Hamilton, ON (S.R.M.) - both in Canada; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Complutense University, Madrid (J.E.); Sinai Hospital of Baltimore System, Baltimore (P.G.); Kerckhoff Clinic, Bad Nauheim (C.W.H.), Deutsches Herzzentrum München, Munich (A.K.), and Helios Amper-Klinikum, Dachau (B.W.) - all in Germany; the Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati (T.H.); Wilhelminenhospital, Vienna (K.H.); Batra Hospital and Medical Research Centre, New Delhi, India (U.K.); Rabin Medical Center, Petach Tikva, Israel (R.K.); Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.K., E.M.O.); the University of Kentucky, Lexington (D.M.); Groupe Hospitalier Bichat-Claude-Bernard, Paris (P.G.S.); Shenyang North Hospital, Shenyang, China (Y.H.); and Beth Israel Deaconess Medical Center, Boston (C.M.G.)
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Fearon WF, Achenbach S, Engstrom T, Assali A, Shlofmitz R, Jeremias A, Fournier S, Kirtane AJ, Kornowski R, Greenberg G, Jubeh R, Kolansky DM, McAndrew T, Dressler O, Maehara A, Matsumura M, Leon MB, De Bruyne B. Accuracy of Fractional Flow Reserve Derived From Coronary Angiography. Circulation 2019; 139:477-484. [PMID: 30586699 DOI: 10.1161/circulationaha.118.037350] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Measuring fractional flow reserve (FFR) with a pressure wire remains underutilized because of the invasiveness of guide wire placement or the need for a hyperemic stimulus. FFR derived from routine coronary angiography (FFRangio) eliminates both of these requirements and displays FFR values of the entire coronary tree. The FFRangio Accuracy versus Standard FFR (FAST-FFR) study is a prospective, multicenter, international trial with the primary goal of determining the accuracy of FFRangio. METHODS Coronary angiography was performed in a routine fashion in patients with suspected coronary artery disease. FFR was measured in vessels with coronary lesions of varying severity using a coronary pressure wire and hyperemic stimulus. Based on angiograms of the respective arteries acquired in ≥2 different projections, on-site operators blinded to FFR then calculated FFRangio using proprietary software. Coprimary end points were the sensitivity and specificity of the dichotomously scored FFRangio for predicting pressure wire-derived FFR using a cutoff value of 0.80. The study was powered to meet prespecified performance goals for sensitivity and specificity. RESULTS Ten centers in the United States, Europe, and Israel enrolled a total of 301 subjects and 319 vessels meeting inclusion/exclusion criteria which were included in the final analysis. The mean FFR was 0.81 and 43% of vessels had an FFR≤0.80. The per-vessel sensitivity and specificity were 94% (95% CI, 88% to 97%) and 91% (86% to 95%), respectively, both of which exceeded the prespecified performance goals. The diagnostic accuracy of FFRangio was 92% overall and remained high when only considering FFR values between 0.75 to 0.85 (87%). FFRangio values correlated well with FFR measurements ( r=0.80, P<0.001) and the Bland-Altman 95% confidence limits were between -0.14 and 0.12. The device success rate for FFRangio was 99%. CONCLUSIONS FFRangio measured from the coronary angiogram alone has a high sensitivity, specificity, and accuracy compared with pressure wire-derived FFR. FFRangio has the promise to substantially increase physiological coronary lesion assessment in the catheterization laboratory, thereby potentially leading to improved patient outcomes. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique Identifier: NCT03226262.
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Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (W.F.F.)
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Germany (S.A.)
| | - Thomas Engstrom
- The Heart Center, Rigs Hospital, University of Copenhagen, Denmark (T.E.)
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel (A.A., R.K.)
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY (R.S., A.J.)
| | - Allen Jeremias
- Department of Cardiology, St. Francis Hospital, Roslyn, NY (R.S., A.J.)
| | - Stephane Fournier
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Belgium (S.F., B.D.B.)
| | - Ajay J Kirtane
- Columbia University Medical Center (A.J.K., A.M., M.B.L.), New York, NY.,Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel (A.A., R.K.)
| | - Gabriel Greenberg
- Department of Cardiology, HaSharon Medical Center, Petach Tikva, Israel (G.G.)
| | - Rami Jubeh
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (R.J.)
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, University of Pennsylvania School of Medicine, Philadelphia (D.M.K.)
| | - Thomas McAndrew
- Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Ovidiu Dressler
- Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Akiko Maehara
- Columbia University Medical Center (A.J.K., A.M., M.B.L.), New York, NY.,Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Martin B Leon
- Columbia University Medical Center (A.J.K., A.M., M.B.L.), New York, NY.,Cardiovascular Research Foundation (A.J.K., A.M., M.B.L., T.M., O.D., M.M.), New York, NY
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Belgium (S.F., B.D.B.)
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Abstract
Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.
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Affiliation(s)
| | - Allen Jeremias
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US
| | | | - Ziad A Ali
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US.,Columbia University Medical Center New York, NY, US
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