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Caforio ALP, Kaski JP, Gimeno JR, Elliott PM, Laroche C, Tavazzi L, Tendera M, Fu M, Sala S, Seferovic PM, Heliö T, Calò L, Blagova O, Amin A, Kindermann I, Sinagra G, Frustaci A, Bonnet D, Charron P, Maggioni AP. Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. Eur Heart J 2024:ehae169. [PMID: 38594778 DOI: 10.1093/eurheartj/ehae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND AIMS Contemporary multicentre data on clinical and diagnostic spectrum and outcome in myocarditis are limited. Study aims were to describe baseline features, 1-year follow-up, and baseline predictors of outcome in clinically suspected or biopsy-proven myocarditis (2013 European Society of Cardiology criteria) in adult and paediatric patients from the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. METHODS Five hundred eighty-one (68.0% male) patients, 493 adults, median age 38 (27-52) years, and 88 children, aged 8 (3-13) years, were divided into 3 groups: Group 1 (n = 233), clinically suspected myocarditis with abnormal cardiac magnetic resonance; Group 2 (n = 222), biopsy-proven myocarditis; and Group 3 (n = 126) clinically suspected myocarditis with normal or inconclusive or no cardiac magnetic resonance. Baseline features were analysed overall, in adults vs. children, and among groups. One-year outcome events included death/heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes. RESULTS Endomyocardial biopsy, mainly right ventricular, had a similarly low complication rate in children and adults (4.7% vs. 4.9%, P = NS), with no procedure-related death. A classical myocarditis pattern on cardiac magnetic resonance was found in 31.3% of children and in 57.9% of adults with biopsy-proven myocarditis (P < .001). At 1-year follow-up, 11/410 patients (2.7%) died, 7 (1.7%) received a heart transplant, 3 underwent VAD (0.7%), and 16 (3.9%) underwent ICD implantation. Independent predictors at diagnosis of death or heart transplantation or hospitalization or VAD implantation or ICD implantation at 1-year follow-up were lower left ventricular ejection fraction and the need for immunosuppressants for new myocarditis diagnosis refractory to non-aetiology-driven therapy. CONCLUSIONS Endomyocardial biopsy was safe, and cardiac magnetic resonance using Lake Louise criteria was less sensitive, particularly in children. Virus-negative lymphocytic myocarditis was predominant both in children and adults, and use of immunosuppressive treatments was low. Lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis were independent predictors of unfavourable outcome events at 1 year.
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Affiliation(s)
- Alida L P Caforio
- Cardiology, Department of Cardiological, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N Giustiniani, 2, Padova 35100, Italy
| | - Juan P Kaski
- Cardiology, University College London and Great Ormond Street Hospital for Children, London, UK
| | - Juan R Gimeno
- Cardiac Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London and St. Bartholomew's Hospital, London, UK
| | - Cecile Laroche
- European Society of Cardiology, EURObservational Research Programme, Biot, France
| | - Luigi Tavazzi
- GVM Care& Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg University, Gothenburg, Sweden
| | - Simone Sala
- Myocarditis Unit, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Petar M Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Roma, Italy
| | - Olga Blagova
- V.N. Vinogradov Faculty Therapeutic Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ahmad Amin
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Homburg/Saar, Germany
| | | | | | - Daniel Bonnet
- M3C-Necker Enfants Malades, AP-HP, Université de Paris Cité, Paris, France
| | - Philippe Charron
- Sorbonne Université, Centre de Référence des Maladies Cardiaques Héréditaires ou Rares, Assistance Publique-Hôpitaux de Paris, ICAN, Inserm UMR1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Aldo P Maggioni
- European Society of Cardiology, EURObservational Research Programme, Biot, France
- ANMCO Research Center, Florence, Italy
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Pinxterhuis TH, von Birgelen C, Geelkerken RH, Doggen CJM, Menting TP, van Houwelingen KG, Linssen GCM, Ploumen EH. Invasiveness of previous treatment for peripheral arterial disease and risk of adverse cardiac events after coronary stenting. Cardiovasc Interv Ther 2024; 39:173-182. [PMID: 38353865 PMCID: PMC10940370 DOI: 10.1007/s12928-024-00986-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/02/2024] [Indexed: 03/07/2024]
Abstract
Patients with peripheral arterial disease (PADs), undergoing percutaneous coronary intervention (PCI), have higher adverse event risks. The effect of invasiveness of PADs treatment on PCI outcome is unknown. This study assessed the impact of the invasiveness of previous PADs treatment (invasive or non-invasive) on event risks after PCI with contemporary drug-eluting stents. This post-hoc analysis pooled 3-year patient-level data of PCI all-comer patients living in the eastern Netherlands, previously treated for PADs. PADs included symptomatic atherosclerotic lesion in the lower or upper extremities; carotid or vertebral arteries; mesenteric arteries or aorta. Invasive PADs treatment comprised endarterectomy, bypass surgery, percutaneous transluminal angioplasty, stenting or amputation; non-invasive treatment consisted of medication and participation in exercise programs. Primary endpoint was (coronary) target vessel failure: composite of cardiac mortality, target vessel-related myocardial infarction, or clinically indicated target vessel revascularization. Of 461 PCI patients with PADs, information on PADs treatment was available in 357 (77.4%) patients; 249 (69.7%) were treated invasively and 108 (30.3%) non-invasively. Baseline and PCI procedural characteristics showed no between-group difference. Invasiveness of PADs treatment was not associated with adverse event risks, including target vessel failure (20.5% vs. 16.0%; HR: 1.30, 95%-CI 0.75-2.26, p = 0.35), major adverse cardiac events (23.3% vs. 20.4%; HR: 1.16, 95%-CI 0.71-1.90, p = 0.55), and all-cause mortality (12.1% vs. 8.3%; HR: 1.48, 95%-CI 0.70-3.13, p = 0.30). In PADs patients participating in PCI trials, we found no significant relation between the invasiveness of previous PADs treatment and 3-year outcome after PCI. Consequently, high-risk PCI patients can be identified by consulting medical records, searching for PADs, irrespective of the invasiveness of PADs treatment.
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Affiliation(s)
- Tineke H Pinxterhuis
- Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Multi-Modality Medical Imaging (M3I) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Theo P Menting
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands.
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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Immens MHM, van den Hoeven V, van Lith TJ, Duijnhouwer TD, ten Cate TJF, de Leeuw FE. Heart-Stroke Team: A multidisciplinary assessment of patent foramen ovale-associated stroke. Eur Stroke J 2024; 9:219-225. [PMID: 37978872 PMCID: PMC10916814 DOI: 10.1177/23969873231214862] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Patent foramen ovale (PFO) closure prevents recurrent ischemic stroke in selected patients with a cryptogenic stroke. Trial results tend to be generalized to daily practice, often extending original trial inclusion criteria. This may result in unnecessary closure without benefit, but with risk of complications. We therefore introduced a standardized and structured evaluation by an interdisciplinary Heart-Stroke Team (HST). Our aim was to investigate the proportion of actual PFO closure of all referred patients with a cryptogenic stroke, after evaluation by the HST. PATIENTS AND METHODS We conducted a single-center, retrospective cohort study. Patients with an assumed cryptogenic ischemic stroke or transient ischemic attack (TIA) and a PFO who were referred for PFO closure were analyzed. As part of the HST approach, all patients underwent a standardized work-up, first to demonstrate the ischemic event on neuroimaging, second to evaluate all potential causes of stroke and finally, to assess the possible relation between the PFO and stroke. Outcome was the proportion of patients treated with PFO closure after referral. RESULTS A total of 195 patients were included. In 124 patients (64%) PFO closure was advised. Fourty-two (22%) patients had a clear alternative cause of stroke and in 13 (7%) patients the initial stroke diagnosis could not be confirmed. CONCLUSION After careful analysis of patients referred for PFO closure a relationship between the PFO and stroke could not be demonstrated in 32% of referrals, and 3% preferred best medical treatment over percutaneous closure. This stresses the need for a complete neurovascular work-up and multidisciplinary assessment.
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Affiliation(s)
- Maikel HM Immens
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Vincent van den Hoeven
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Theresa J van Lith
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Toon D Duijnhouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim JF ten Cate
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Laenens D, Stassen J, Galloo X, Ewe SH, Singh GK, Ammanullah MR, Hirasawa K, Sia CH, Butcher SC, Chew NWS, Kong WKF, Poh KK, Ding ZP, Ajmone Marsan N, Bax JJ. The impact of atrial fibrillation on prognosis in aortic stenosis. Eur Heart J Qual Care Clin Outcomes 2023; 9:778-784. [PMID: 36669758 PMCID: PMC10745267 DOI: 10.1093/ehjqcco/qcad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor. OBJECTIVE To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function. METHODS Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality. RESULTS In total, 2849 patients with significant AS (mean age 72 ± 12 years, 54.8% men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30-97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P < 0.001). On univariable (HR: 1.42; 95% CI: 1.25-1.62; P < 0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02-1.38; P = 0.026), AF was independently associated with mortality. However, when correcting for indexed left atrial volume, E/e' or both, AF was no longer independently associated with all-cause mortality. CONCLUSION Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.
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Affiliation(s)
- Dorien Laenens
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mohammed R Ammanullah
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA 6000, Australia
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Zee P Ding
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Turku Heart Center, University of Turku and Turku Unviersity Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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Santos-Pardo I, Witt N, Angerås O, Nyström T. Effects of exenatide on coronary stent's endothelialization in subjects with type 2 diabetes: a randomized controlled trial. The Rebuild study. Cardiovasc Diabetol 2023; 22:337. [PMID: 38066597 PMCID: PMC10709975 DOI: 10.1186/s12933-023-02071-4] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Subjects with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis. The activation of the glucagon-like peptide-1 receptor (GLP-1R) has been suggested to induce several effects on the vasculature that may reduce the risk of stent failure following an angioplasty. The aim of this study is to evaluate the effect of the GLP-1R agonist exenatide on endothelialization of a modern drug-eluting stent (DES) in subjects with T2D. METHODS 38 subjects with T2D who were eligible for revascularization with implantation of DES were randomized to treatment with exenatide (once weekly) plus standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the percentage of strut coverage (primary endpoint) and the presence of neo-atherosclerosis by optical coherence tomography. This study was approved by the Stockholm's Ethical Review Board. RESULTS The two groups were well balanced regarding baseline clinical characteristics. Strut coverage was 95% (88.7-98.5%) in the exenatide group and 91.4% (88.8-98.5%) in the control group (p = 0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p = 0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in exenatide group vs 14.7% in control group, p = 0.801). No significant differences were detected in the rate of target lesion revascularization between groups (p = 0.224). CONCLUSION Twelve weeks treatment with exenatide did not lead to a significantly better stent coverage in people with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov (Rebuild Study, NCT02621489).
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Affiliation(s)
- Irene Santos-Pardo
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden.
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Unit of Internal Medicine, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
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Patel KP, Mukhopadhyay S, Bedford K, Richards R, Queenan H, Jerrum M, Banton J, Ozkor M, Mathur A, Kennon S, Baumbach A, Mullen MJ. Rapid Assessment and Treatment In Decompensated Aortic Stenosis (ASTRID-AS study)- A pilot study. Eur Heart J Qual Care Clin Outcomes 2023; 9:724-730. [PMID: 36378116 PMCID: PMC10627808 DOI: 10.1093/ehjqcco/qcac074] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute decompensated aortic stenosis (ADAS) is common and associated with higher mortality, acute kidney injury (AKI) and longer hospital length of stay (LoS) compared with electively treated stable AS. The aim of this study was to assess the impact of a dedicated pathway that reduces time to transcatheter aortic valve implantation (TAVI) in ADAS, hypothesizing that LoS can be reduced without compromising patient safety. METHODS AND RESULTS Using a prospective, open label, cluster design, patients from 5 referring centres were allocated to the ASessment and TReatment In Decompensated Aortic Stenosis (ASTRID-AS) pathway where the diagnosis, referral, investigations and treatment of ADAS were prioritised and expedited. 15 hospitals remained on the conventional pathway that followed the same process, albeit according to a waiting list. The primary efficacy endpoint was hospital LoS and the secondary safety endpoint, a composite of death or AKI at 30 days post-TAVI. 58 conventional patients and 25 ASTRID-AS patients were included in this study. Time to TAVI in the conventional vs. ASTRID-AS cohort was 22 (15-30) vs. 10 (6-12) days; P < 0.001, respectively. Length of hospital stay was 24 (18-33) vs. 13 (8-18) days; P < 0.001, respectively. 13.4 bed days were saved per patient using the ASTRID-AS pathway. Secondary safety endpoint occurred in 12 (20.7%) vs. 1 (4.0%) patients; P = 0.093, respectively. Procedural complications were similar between the two cohorts. CONCLUSION A dedicated pathway for ADAS that shortens time to TAVI demonstrated reduced hospital LoS without compromising patient safety and a trend towards improving clinical outcomes.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | | | - Kerry Bedford
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Rhian Richards
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Helen Queenan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Melanie Jerrum
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Judy Banton
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Mick Ozkor
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
| | - Simon Kennon
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Andreas Baumbach
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
- Yale University School of Medicine, New Haven, CT 06510. USA
| | - Michael J Mullen
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
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Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, Price MJ, Hill JM, Akasaka T, Prati F, Bezerra HG, Wijns W, Leistner D, Canova P, Alfonso F, Fabbiocchi F, Dogan O, McGreevy RJ, McNutt RW, Nie H, Buccola J, West NEJ, Stone GW. Optical Coherence Tomography-Guided versus Angiography-Guided PCI. N Engl J Med 2023; 389:1466-1476. [PMID: 37634188 DOI: 10.1056/nejmoa2305861] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Data regarding clinical outcomes after optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) as compared with angiography-guided PCI are limited. METHODS In this prospective, randomized, single-blind trial, we randomly assigned patients with medication-treated diabetes or complex coronary-artery lesions to undergo OCT-guided PCI or angiography-guided PCI. A final blinded OCT procedure was performed in patients in the angiography group. The two primary efficacy end points were the minimum stent area after PCI as assessed with OCT and target-vessel failure at 2 years, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization. Safety was also assessed. RESULTS The trial was conducted at 80 sites in 18 countries. A total of 2487 patients underwent randomization: 1233 patients were assigned to undergo OCT-guided PCI, and 1254 to undergo angiography-guided PCI. The minimum stent area after PCI was 5.72±2.04 mm2 in the OCT group and 5.36±1.87 mm2 in the angiography group (mean difference, 0.36 mm2; 95% confidence interval [CI], 0.21 to 0.51; P<0.001). Target-vessel failure within 2 years occurred in 88 patients in the OCT group and in 99 patients in the angiography group (Kaplan-Meier estimates, 7.4% and 8.2%, respectively; hazard ratio, 0.90; 95% CI, 0.67 to 1.19; P = 0.45). OCT-related adverse events occurred in 1 patient in the OCT group and in 2 patients in the angiography group. Stent thrombosis within 2 years occurred in 6 patients (0.5%) in the OCT group and in 17 patients (1.4%) in the angiography group. CONCLUSIONS Among patients undergoing PCI, OCT guidance resulted in a larger minimum stent area than angiography guidance, but there was no apparent between-group difference in the percentage of patients with target-vessel failure at 2 years. (Funded by Abbott; ILUMIEN IV: OPTIMAL PCI ClinicalTrials.gov number, NCT03507777.).
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Affiliation(s)
- Ziad A Ali
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Ulf Landmesser
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Akiko Maehara
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Mitsuaki Matsumura
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Richard A Shlofmitz
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Giulio Guagliumi
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Matthew J Price
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Jonathan M Hill
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Takashi Akasaka
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Francesco Prati
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Hiram G Bezerra
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - William Wijns
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - David Leistner
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Paolo Canova
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Fernando Alfonso
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Franco Fabbiocchi
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Ozgen Dogan
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Robert J McGreevy
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Robert W McNutt
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Hong Nie
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Jana Buccola
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Nick E J West
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
| | - Gregg W Stone
- From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.)
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8
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Shiomi H, Kozuma K, Morimoto T, Kadota K, Tanabe K, Morino Y, Tamura T, Abe M, Suwa S, Ito Y, Kobayashi M, Dai K, Nakao K, Tarutani Y, Taniguchi R, Nishikawa H, Yamamoto Y, Yamasaki T, Okamura A, Nakagawa Y, Ando K, Kobayashi K, Kawai K, Hibi K, Kimura T. Ten-year clinical outcomes from a randomized trial comparing new-generation everolimus-eluting stent versus first-generation Sirolimus-eluting stent: Results from the RESET extended study. Catheter Cardiovasc Interv 2023; 102:594-607. [PMID: 37545171 DOI: 10.1002/ccd.30791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND New-generation drug-eluting stents (DES) achieved technological innovations and reported clinical advantages as compared with first-generation DES in clinical trials with 3-5 years follow-up. However, detailed clinical outcome data in very long-term follow-up is still scarce. OBJECTIVES To evaluate 10-year clinical outcomes after first- and new-generation DES implantation. METHODS In this extende follow-up study of the RESET, which is a largest randomized trial comparing everolimus-eluting stent (EES) with Sirolimus-eluting stent (SES), the study population consisted of 2892 patients from 84 centers. The primary efficacy and safety endpoints were target lesion revascularization (TLR) and a composite of death or myocardial infarction (MI), respectively. Complete 10-year follow-up was achieved in 87.9% of patients. RESULTS Cumulative 10-year incidences of TLR and non-TLR were not significantly different between EES and SES (13.9% vs. 15.7%, Log-rank p = 0.20, and 33.4% vs. 31.3%, Log-rank p = 0.30). The cumulative 10-year incidence of death/MI was also not significantly different between the groups (32.5% vs. 34.4%, Log-rank p = 0.18). Cumulative 10-year incidence of definite stent thrombosis was numerically lower in EES than in SES (1.0% vs. 1.7%, Log-rank p = 0.16). The lower risk of EES relative to SES was significant for a composite endpoint of target lesion failure (TLF: 19.6% vs. 24.9%, Log-rank p = 0.001) and target vessel failure (TVF: 26.7% vs. 31.4%, Log-rank p = 0.006). CONCLUSION During 10-year of follow-up, the risks for primary efficacy and safety endpoints were not significantly different between new-generation EES and first-generation SES, although EES compared with SES was associated with a lower risk for composite endpoints such as TLF and TVF.
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Affiliation(s)
- Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | | | - Mitsuru Abe
- National Hospital Organization Kyoto Medical Center, Division of Cardiology, Kyoto, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Yokohama, Japan
| | | | - Kazuoki Dai
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Koichi Nakao
- Saiseikai Kumamoto Hospital Cardiovascular Center, Division of Cardiology, Kumamoto, Japan
| | | | - Ryoji Taniguchi
- Hyogo Prefectural Amagasaki General Medical Center, Division of Cardiology, Amagasaki, Japan
| | | | | | - Tomohiro Yamasaki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Kazuya Kawai
- Division of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kiyoshi Hibi
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
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Lee Y, Shin JH, Seo SM, Choi IJ, Lee JY, Lee JW, Park MW, Kang TS, Choi WG, Jeon KH, Lim HS, Joo HJ, Rhee SJ, Seo JB, Park MS, Park SH, Lim YH. Influence of early dose reduction of ticagrelor on clinical outcomes following percutaneous coronary intervention for complex lesions. Sci Rep 2023; 13:15481. [PMID: 37726368 PMCID: PMC10509174 DOI: 10.1038/s41598-023-42655-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
Ticagrelor-based dual antiplatelet therapy (DAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the influence of early ticagrelor dose reduction (120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients who received standard-dose ticagrelor-based DAPT (180 mg) after PCI for complex lesions. Major adverse cardiovascular event (MACE: a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization), bleeding, and net adverse clinical events (NACE: a composite of MACE and bleeding) were assessed. Among the 772 patients on standard-dose ticagrelor-based DAPT, 115 (14.8%) switched to low-dose ticagrelor-based DAPT (120 mg) within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariable Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding, and NACE were not different between the low-dose and standard-dose groups throughout the entire follow-up period and the period beyond 6 months post-PCI. Time-varying multivariable CPH models of the ticagrelor dose reduction yielded similar results. A reduction of the ticagrelor dose within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.
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Affiliation(s)
- Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Suk Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Mahn-Won Park
- Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Tae Soo Kang
- Division of Cardiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Woong Gil Choi
- Department of Internal Medicine, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, 28644, Republic of Korea
| | - Ki-Hyun Jeon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang Jae Rhee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung Soo Park
- Division of Cardiology, Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Sang-Ho Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
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10
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Nadarajah R, Ludman P, Laroche C, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP. Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology. Eur Heart J Qual Care Clin Outcomes 2023; 9:552-563. [PMID: 36737420 PMCID: PMC10495699 DOI: 10.1093/ehjqcco/qcad008] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification. METHODS AND RESULTS Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P < 0.001) exhibited an inverse economic gradient. CONCLUSION Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 3AA, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, LS2 9NL, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, European Heart House, Route des Colles, Sophia Antipolis, 2035, France
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
- Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Begrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 3AA, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, LS2 9NL, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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11
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Yang S, Koo BK. Coronary Physiology-Based Approaches for Plaque Vulnerability: Implications for Risk Prediction and Treatment Strategies. Korean Circ J 2023; 53:581-593. [PMID: 37653694 PMCID: PMC10475684 DOI: 10.4070/kcj.2023.0117] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 09/02/2023] Open
Abstract
In the catheterization laboratory, the measurement of physiological indexes can help identify functionally significant lesions and has become one of the standard methods to guide treatment decision-making. Plaque vulnerability refers to a coronary plaque susceptible to rupture, enabling risk prediction before coronary events, and it can be detected by defining a certain type of plaque morphology on coronary imaging modalities. Although coronary physiology and plaque vulnerability have been considered different attributes of coronary artery disease, the underlying pathophysiological basis and clinical data indicate a strong correlation between coronary hemodynamic properties and vulnerable plaque. In prediction of coronary events, emerging data have suggested independent and additional implications of a physiology-based approach to a plaque-based approach. This review covers the fundamental interplay between coronary physiology and plaque morphology during disease progression with clinical data supporting this relationship and examines the clinical relevance of physiological indexes in prediction of clinical outcomes and therapeutic decision-making along with plaque vulnerability.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, Korea.
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12
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van der Sangen NMR, Claessen BEPM, Küçük IT, den Hartog AW, Kikkert WJ, Appelman Y, Henriques JPS. One-year follow-up of patients treated with single antiplatelet therapy directly after percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome. Eur Heart J Open 2023; 3:oead075. [PMID: 37680589 PMCID: PMC10482140 DOI: 10.1093/ehjopen/oead075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Abstract
Graphical AbstractClinical outcomes and treatment adherence during 12 months follow-up. *Second bleeding event in same patient. PCI, percutaneous coronary intervention; TVR, target vessel revascularization.
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Affiliation(s)
- Niels M R van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - I Tarik Küçük
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Alexander W den Hartog
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wouter J Kikkert
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Tergooi Hospital, Hilversum, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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13
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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14
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van de Velde L, Groot Jebbink E, Zambrano BA, Versluis M, Tessarek J, Reijnen MMPJ. The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms. Cardiovasc Intervent Radiol 2022; 45:858-866. [PMID: 35378613 PMCID: PMC9117362 DOI: 10.1007/s00270-022-03118-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
Purpose The feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models. Materials and Methods Six popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation. Results On average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15–20 s, compared to 5–15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents. Conclusion A compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03118-x.
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Affiliation(s)
- L van de Velde
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
- Physics of Fluids Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
- M3i Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - E Groot Jebbink
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- M3i Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - B A Zambrano
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
| | - M Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - J Tessarek
- Department of Vascular Surgery, Bonifatius Hospital, Lingen, Germany
| | - M M P J Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- M3i Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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15
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Mol JQ, Belkacemi A, Volleberg RH, Meuwissen M, Protopopov AV, Laanmets P, Krestyaninov OV, Dennert R, Oemrawsingh RM, van Kuijk JP, Arkenbout K, van der Heijden DJ, Rasoul S, Lipsic E, Teerenstra S, Camaro C, Damman P, van Leeuwen MA, van Geuns RJ, van Royen N. Identification of anatomic risk factors for acute coronary events by optical coherence tomography in patients with myocardial infarction and residual nonflow limiting lesions: rationale and design of the PECTUS-obs study. BMJ Open 2021; 11:e048994. [PMID: 34233996 PMCID: PMC8264896 DOI: 10.1136/bmjopen-2021-048994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In patients with myocardial infarction, the decision to treat a nonculprit lesion is generally based on its physiological significance. However, deferral of revascularisation based on nonischaemic fractional flow reserve (FFR) values in these patients results in less favourable outcomes compared with patients with stable coronary artery disease, potentially caused by vulnerable nonculprit lesions. Intravascular optical coherence tomography (OCT) imaging allows for in vivo morphological assessment of plaque 'vulnerability' and might aid in the detection of FFR-negative lesions at high risk for recurrent events. METHODS AND ANALYSIS The PECTUS-obs study is an international multicentre prospective observational study that aims to relate OCT-derived vulnerable plaque characteristics of nonflow limiting, nonculprit lesions to clinical outcome in patients with myocardial infarction. A total of 438 patients presenting with myocardial infarction (ST-elevation myocardial infarction and non-ST-elevation myocardial infarction) will undergo OCT-imaging of any FFR-negative nonculprit lesion for detection of plaque vulnerability. The primary study endpoint is a composite of major adverse cardiovascular events (all-cause mortality, nonfatal myocardial infarction or unplanned revascularisation) at 2-year follow-up. Secondary endpoints will be the same composite at 1-year and 5-year follow-up, target vessel failure, target vessel revascularisation, target lesion failure and target lesion revascularisation. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethics Committee of the region Arnhem-Nijmegen. The results of this study will be disseminated in a main paper and additional papers with subgroup analyses. TRIAL REGISTRATION NUMBER NCT03857971.
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Affiliation(s)
- Jan-Quinten Mol
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Anouar Belkacemi
- Department of Cardiology, Isala Hospitals, Zwolle, The Netherlands
| | | | | | - Alexey V Protopopov
- Cardiovascular Center, Regional Clinical Hospital, Krasnoyarsk, Russian Federation
| | - Peep Laanmets
- Department of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Oleg V Krestyaninov
- Department of Cardiology, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Robert Dennert
- Department of Cardiology, Dr Horacio E Oduber Hospital, Oranjestad, Aruba
| | - Rohit M Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Karin Arkenbout
- Department of Cardiology, Tergooi Hospitals, Blaricum, The Netherlands
| | | | - Saman Rasoul
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Cardiology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Steven Teerenstra
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboudumc, Nijmegen, The Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Peter Damman
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Niels van Royen
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
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16
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Messerli FH, Hofstetter L, Syrogiannouli L, Rexhaj E, Siontis GCM, Seiler C, Bangalore S. Sodium intake, life expectancy, and all-cause mortality. Eur Heart J 2021; 42:2103-2112. [PMID: 33351135 PMCID: PMC8169157 DOI: 10.1093/eurheartj/ehaa947] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/08/2019] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Since dietary sodium intake has been identified as a risk factor for cardiovascular disease and premature death, a high sodium intake can be expected to curtail life span. We tested this hypothesis by analysing the relationship between sodium intake and life expectancy as well as survival in 181 countries worldwide. METHODS AND RESULTS We correlated age-standardized estimates of country-specific average sodium consumption with healthy life expectancy at birth and at age of 60 years, death due to non-communicable diseases and all-cause mortality for the year of 2010, after adjusting for potential confounders such as gross domestic product per capita and body mass index. We considered global health estimates as provided by World Health Organization. Among the 181 countries included in this analysis, we found a positive correlation between sodium intake and healthy life expectancy at birth (β = 2.6 years/g of daily sodium intake, R2 = 0.66, P < 0.001), as well as healthy life expectancy at age 60 (β = 0.3 years/g of daily sodium intake, R2 = 0.60, P = 0.048) but not for death due to non-communicable diseases (β = 17 events/g of daily sodium intake, R2 = 0.43, P = 0.100). Conversely, all-cause mortality correlated inversely with sodium intake (β = -131 events/g of daily sodium intake, R2 = 0.60, P < 0.001). In a sensitivity analysis restricted to 46 countries in the highest income class, sodium intake continued to correlate positively with healthy life expectancy at birth (β = 3.4 years/g of daily sodium intake, R2 = 0.53, P < 0.001) and inversely with all-cause mortality (β = -168 events/g of daily sodium intake, R2 = 0.50, P < 0.001). CONCLUSION Our observation of sodium intake correlating positively with life expectancy and inversely with all-cause mortality worldwide and in high-income countries argues against dietary sodium intake being a culprit of curtailing life span or a risk factor for premature death. These data are observational and should not be used as a base for nutritional interventions.
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Affiliation(s)
- Franz H Messerli
- Swiss Cardiovascular Center, Bern University Hospital, University of Bern, Freiburgstr. 18, Bern 3010, Switzerland
- Jagiellonian University, Krakow, Poland
- Division of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, New York, NY, USA
| | - Louis Hofstetter
- Swiss Cardiovascular Center, Bern University Hospital, University of Bern, Freiburgstr. 18, Bern 3010, Switzerland
| | | | - Emrush Rexhaj
- Swiss Cardiovascular Center, Bern University Hospital, University of Bern, Freiburgstr. 18, Bern 3010, Switzerland
| | - George C M Siontis
- Swiss Cardiovascular Center, Bern University Hospital, University of Bern, Freiburgstr. 18, Bern 3010, Switzerland
| | - Christian Seiler
- Swiss Cardiovascular Center, Bern University Hospital, University of Bern, Freiburgstr. 18, Bern 3010, Switzerland
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
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Abstract
Contemporary data indicate that patients with signs and symptoms of ischaemia and non-obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) with elevated risk for adverse outcomes. Coronary endothelial (constriction with acetylcholine) and/or microvascular (limited coronary flow reserve with adenosine) dysfunction are well-documented, and extensive non-obstructive atherosclerosis is often present. Despite these data, patients with INOCA currently remain under-treated, in part, because existing management guidelines do not address this large, mostly female population due to the absence of evidence-based data. Relatively small sample-sized, short-term pilot studies of symptomatic mostly women, with INOCA, using intense medical therapies targeting endothelial, microvascular, and/or atherosclerosis mechanisms suggest symptom, ischaemia, and coronary vascular functional improvement, however, randomized, controlled outcome trials testing treatment strategies have not been completed. We review evidence regarding CMD pharmacotherapy. Potent statins in combination with angiotensin-converting enzyme inhibitor (ACE-I) or receptor blockers if intolerant, at maximally tolerated doses appear to improve angina, stress testing, myocardial perfusion, coronary endothelial function, and microvascular function. The Coronary Microvascular Angina trial supports invasive diagnostic testing with stratified therapy as an approach to improve symptoms and quality of life. The WARRIOR trial is testing intense medical therapy of high-intensity statin, maximally tolerated ACE-I plus aspirin on longer-term outcomes to provide evidence for guidelines. Novel treatments and those under development appear promising as the basis for future trial planning.
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Affiliation(s)
- C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, 1329 SW 16th Street, PO Box 100288, Gainesville, FL 32610-0288, USA
| | - Hiroki Shimokawa
- Division of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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18
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Felix CM, van den Berg VJ, Hoeks SE, Fam JM, Lenzen M, Boersma E, Smits PC, Serruys PW, Onuma Y, van Geuns RJM. Mid-term outcomes of the Absorb BVS versus second-generation DES: A systematic review and meta-analysis. PLoS One 2018; 13:e0197119. [PMID: 29742143 PMCID: PMC5942828 DOI: 10.1371/journal.pone.0197119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Bioresorbable Vascular Scaffolds (BVS) were introduced to overcome some of the limitations of drug-eluting stent (DES) for PCI. Data regarding the clinical outcomes of the BVS versus DES beyond 2 years are emerging. Objective To study mid-term outcomes. Methods We searched online databases (PubMed/Medline, Embase, CENTRAL), several websites, meeting presentations and scientific session abstracts until August 8th, 2017 for studies comparing Absorb BVS with second-generation DES. The primary outcome was target lesion failure (TLF). Secondary outcomes were all-cause mortality, myocardial infarction, target lesion revascularization (TLR) and definite/probable device thrombosis. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived using a random effects model. Results Ten studies, seven randomized controlled trials and three propensity-matched observational studies, with a total of 7320 patients (BVS n = 4007; DES n = 3313) and a median follow-up duration of 30.5 months, were included. Risk of TLF was increased for BVS-treated patients (OR 1.34 [95% CI: 1.12–1.60], p = 0.001, I2 = 0%). This was also the case for all myocardial infarction (1.58 [95% CI: 1.27–1.96], p<0.001, I2 = 0%), TLR (1.48 [95% CI: 1.19–1.85], p<0.001, I2 = 0%) and definite/probable device thrombosis (of 2.82 (95% CI: 1.86–3.89], p<0.001 and I2 = 40.3%). This did not result in a difference in all-cause mortality (0.78 [95% CI: 0.58–1.04], p = 0.09, I2 = 0%). OR for very late (>1 year) device thrombosis was 6.10 [95% CI: 1.40–26.65], p = 0.02). Conclusion At mid-term follow-up, BVS was associated with an increased risk of TLF, MI, TLR and definite/probable device thrombosis, but this did not result in an increased risk of all-cause mortality.
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Affiliation(s)
- Cordula M. Felix
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Sanne E. Hoeks
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jiang Ming Fam
- Cardiology department, National Heart Centre Singapore, Singapore
| | - Mattie Lenzen
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Eric Boersma
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Peter C. Smits
- Cardiology department, Maasstad Hospital, Rotterdam, the Netherlands
| | - Patrick W. Serruys
- Cardiology department, The National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Yoshinobu Onuma
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Robert Jan M. van Geuns
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
- Cardiology department, Radboud UMC, Nijmegen, the Netherlands
- * E-mail:
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19
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von zur Mühlen C, Reiss S, Krafft AJ, Besch L, Menza M, Zehender M, Heidt T, Maier A, Pfannebecker T, Zirlik A, Reinöhl J, Stachon P, Hilgendorf I, Wolf D, Diehl P, Wengenmayer T, Ahrens I, Bode C, Bock M. Coronary magnetic resonance imaging after routine implantation of bioresorbable vascular scaffolds allows non-invasive evaluation of vascular patency. PLoS One 2018; 13:e0191413. [PMID: 29370208 PMCID: PMC5784929 DOI: 10.1371/journal.pone.0191413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/04/2018] [Indexed: 12/17/2022] Open
Abstract
Background Evaluation of recurrent angina after percutaneous coronary interventions is challenging. Since bioresorbable vascular scaffolds (BVS) cause no artefacts in magnetic resonance imaging (MRI) due to their polylactate-based backbone, evaluation of vascular patency by MRI might allow for non-invasive assessment and triage of patients with suspected BVS failure. Methods Patients with polylactate-based ABSORB-BVS in proximal coronary segments were examined with 3 Tesla MRI directly (baseline) and one year after implantation. For assessment of coronary patency, a high-resolution 3D spoiled gradient echo pulse sequence with fat-saturation, T2-preparation (TE: 40 ms), respiratory and end-diastolic cardiac gating, and a spatial resolution of (1.08 mm)3 was positioned parallel to the course of the vessel for bright blood imaging. In addition, a 3D navigator-gated T2-weighted variable flip angle turbo spin echo (TSE) sequence with dual-inversion recovery black-blood preparation and elliptical k-space coverage was applied with a voxel size of (1.14 mm)3. For quantitative evaluation lumen diameters of the scaffolded areas were measured in reformatted bright and black blood MR angiography data. Results 11 patients with implantation of 16 BVS in the proximal coronary segments were included, of which none suffered from major adverse cardiac events during the one year follow up. Vascular patency in all segments implanted with BVS could be reliably assessed by MRI at baseline and after one year, whereas segments with metal stents could not be evaluated due to artefacts. Luminal diameter within the BVS remained constant during the one year period. One patient with atypical angina after BVS implantation was noninvasively evaluated showing a patent vessel, also confirmed by coronary angiography. Conclusions Coronary MRI allows contrast-agent free and non-invasive assessment of vascular patency after ABSORB-BVS implantation. This approach might be supportive in the triage and improvement of diagnostic workflows in patients with postinterventional angina and scaffold implantation. Trial registration German Register of Clinical Studies DRKS00007456
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Affiliation(s)
- Constantin von zur Mühlen
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Simon Reiss
- Department of Radiology–Medical Physics, University Medical Center Freiburg, Freiburg, Germany
| | - Axel J. Krafft
- Department of Radiology–Medical Physics, University Medical Center Freiburg, Freiburg, Germany
| | - Lisa Besch
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marius Menza
- Department of Radiology–Medical Physics, University Medical Center Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Maier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Ahrens
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology–Medical Physics, University Medical Center Freiburg, Freiburg, Germany
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20
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Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Kalten K, Brennan AL, Lefkovits J, Hiew C, Oqueli E, Reid CM, Duffy SJ, Clark DJ. The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry. BMJ Open 2017; 7:e016874. [PMID: 28988174 PMCID: PMC5640050 DOI: 10.1136/bmjopen-2017-016874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary prevention pharmacotherapy. METHODS Consecutive patients from the Melbourne Interventional Group registry (2005-2013) who were alive at 30 days post-ACS presentation were included in our observational cohort study. Patients were divided into four categories based on their smoking status: non-smoker; ex-smoker (quit >1 month before ACS); recent quitter (smoker at presentation but quit by 30 days) and persistent smoker (smoker at presentation and at 30 days). The primary endpoint was survival ascertained through the Australian National Death Index linkage. A Cox-proportional hazards model was used to estimate the adjusted HR and 95% CI for survival. RESULTS Of the 9375 patients included, 2728 (29.1%) never smoked, 3712 (39.6%) were ex-smokers, 1612 (17.2%) were recent quitters and 1323 (14.1%) were persistent smokers. Cox-proportional hazard modelling revealed, compared with those who had never smoked, that persistent smoking (HR 1.78, 95% CI 1.36 to 2.32, p<0.001) was an independent predictor of increased hazard (mean follow-up 3.9±2.2 years) while being a recent quitter (HR 1.27, 95% CI 0.96 to 1.68, p=0.10) or an ex-smoker (HR 1.03, 95% CI 0.87 to 1.22, p=0.72) were not. CONCLUSIONS In a contemporary cohort of patients with ACS, those who continued to smoke had an 80% risk of lower survival while those who quit had comparable survival to lifelong non-smokers. This underscores the importance of smoking cessation in secondary prevention despite the improvement in management of ACS with PCI and pharmacotherapy.
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Affiliation(s)
- Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Andrew E Ajani
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Katie Kalten
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, Barwon Health, Geelong, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Western Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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van Ditzhuijzen NS, Kurata M, van den Heuvel M, Sorop O, van Duin RWB, Krabbendam-Peters I, Ligthart J, Witberg K, Murawska M, Bouma B, Villiger M, Garcia-Garcia HM, Serruys PW, Zijlstra F, van Soest G, Duncker DJ, Regar E, van Beusekom HMM. Neoatherosclerosis development following bioresorbable vascular scaffold implantation in diabetic and non-diabetic swine. PLoS One 2017; 12:e0183419. [PMID: 28898243 PMCID: PMC5595285 DOI: 10.1371/journal.pone.0183419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background DM remains a risk factor for poor outcome after stent-implantation, but little is known if and how DM affects the vascular response to BVS. Aim The aim of our study was to examine coronary responses to bioresorbable vascular scaffolds (BVS) in swine with and without diabetes mellitus fed a ‘fast-food’ diet (FF-DM and FF-NDM, respectively) by sequential optical coherence tomography (OCT)-imaging and histology. Methods Fifteen male swine were evaluated. Eight received streptozotocin-injection to induce DM. After 9 months (M), 32 single BVS were implanted in epicardial arteries with a stent to artery (S/A)-ratio of 1.1:1 under quantitative coronary angiography (QCA) and OCT guidance. Lumen, scaffold, neointimal coverage and composition were assessed by QCA, OCT and near-infrared spectroscopy (NIRS) pre- and/or post-procedure, at 3M and 6M. Additionally, polarization-sensitive (PS)-OCT was performed in 7 swine at 6M. After sacrifice at 3M and 6M, histology and polymer degradation analysis were performed. Results Late lumen loss was high (~60%) within the first 3M after BVS-implantation (P<0.01 FF-DM vs. FF-NDM) and stabilized between 3M and 6M (<5% change in FF-DM, ~10% in FF-NDM; P>0.20). Neointimal coverage was highly heterogeneous in all swine (DM vs. NDM P>0.05), with focal lipid accumulation, irregular collagen distribution and neointimal calcification. Likewise, polymer mass loss was low (~2% at 3M, ~5% at 6M;P>0.20) and not associated with DM or inflammation. Conclusion Scaffold coverage showed signs of neo-atherosclerosis in all FF-DM and FF-NDM swine, scaffold polymer was preserved and the vascular response to BVS was not influenced by diabetes.
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Affiliation(s)
- Nienke S. van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mie Kurata
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W. B. van Duin
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Magdalena Murawska
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Brett Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Jan Duncker
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dept. of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Heleen M. M. van Beusekom
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Leonardi S, Marino M, Crimi G, Maiorana F, Rizzotti D, Lettieri C, Bettari L, Zuccari M, Sganzerla P, Tresoldi S, Adamo M, Ghiringhelli S, Sponzilli C, Pasquetto G, Pavei A, Pedon L, Bassan L, Bollati M, Camisasca P, Trabattoni D, Brancati M, Poli A, Panciroli C, Lettino M, Tarelli G, Tarantini G, De Luca L, Varbella F, Musumeci G, De Servi S. APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study. BMJ Open 2017; 7:e016909. [PMID: 28877948 PMCID: PMC5588962 DOI: 10.1136/bmjopen-2017-016909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. DESIGN Retrospective, pilot study. SETTING 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. PARTICIPANTS 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. RESULTS Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). CONCLUSIONS Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement. TRIAL REGISTRATION NUMBER NCT02748603.
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Affiliation(s)
- Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gabriele Crimi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Florinda Maiorana
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Rizzotti
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Luca Bettari
- Cardiology, ASST Cremona–Ospedale di Cremona, Cremona, Italy
| | - Marco Zuccari
- Cardiology, Ospedale Fornaroli di Magenta, Magenta, Italy
| | - Paolo Sganzerla
- Cardiology, ASST Bergamo Ovest–Ospedale di Treviglio, Treviglio, Italy
| | - Simone Tresoldi
- Cardiology, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy
| | | | | | | | - Giampaolo Pasquetto
- Cardiology, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy
| | - Andrea Pavei
- Cardiology, Presidio Ospedaliero di Conegliano, Conegliano, Italy
| | - Luigi Pedon
- Cardiology, Presidio Ospedaliero di Cittadella, Cittadella, Italy
| | | | - Mario Bollati
- Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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