1
|
Bujak K, Vidal-Cales P, Gabani R, Rinaldi R, Gomez-Lara J, Ortega-Paz L, Jimenez-Diaz V, Jimenez-Kockar M, Jimenez-Quevedo P, Diletti R, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, De Miguel-Castro A, Iñiguez A, Nombela-Franco L, Ielasi A, Tespili M, Lenzen M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Gasior M, Serruys PW, Sabate M, Brugaletta S. Relationship between stent length and very long-term target lesion failure following percutaneous coronary intervention for ST-elevation myocardial infarction in the drug-eluting stents era: insights from the EXAMINATION-EXTEND study. Am Heart J 2023; 264:72-82. [PMID: 37279839 DOI: 10.1016/j.ahj.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Little data exist on the relationship between total stent length (TSL) and cardiovascular outcomes at very-long follow-up in patients with ST-elevation myocardial infarction (STEMI) in the 2nd generation drug-eluting stents (DES) era. AIM To analyze the relationship between TSL and 10-year target-lesion failure (TLF) in STEMI patients treated with percutaneous coronary intervention enrolled in the EXAMINATION-EXTEND. METHODS The EXAMINATION-EXTEND was an extended-follow-up study of the EXAMINATION trial, which randomized 1:1 STEMI patients to receive DES or bare metal stent (BMS). The primary endpoint was TLF, defined as a composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), or definite/probable stent thrombosis (ST). Relationship between stent length and TLF was evaluated in the whole study group in a multiple-adjusted Cox regression model with TSL as a quantitative variable. Subgroup analysis was also performed according to stent type, diameter, and overlap. RESULTS A total of 1,489 patients with a median TSL of 23 mm (Q1-Q318-35 mm) were included. TSL was associated with TLF at 10 years (adjusted HR per 5 mm increase of 1.07; 95% CI, 1.01-1.14; P = .02). This effect was mainly driven by TLR and was consistent regardless of stent type, diameter, or overlap. There was no significant relationship between TSL and TV-MI or ST. CONCLUSIONS In STEMI patients, there is a direct relationship between TSL implanted in the culprit vessel and the risk of TLF at 10 years, mainly driven by TLR. The use of DES did not modify this association.
Collapse
Affiliation(s)
- Kamil Bujak
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Pablo Vidal-Cales
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Riccardo Rinaldi
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Roberto Diletti
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | - Mattie Lenzen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Mariusz Gasior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabate
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| |
Collapse
|
2
|
Spione F, Arevalos V, Gabani R, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Impact of Diabetes on 10-Year Outcomes Following ST-Segment-Elevation Myocardial Infarction: Insights From the EXAMINATION-EXTEND Trial. J Am Heart Assoc 2022; 11:e025885. [PMID: 36444863 PMCID: PMC9851431 DOI: 10.1161/jaha.122.025885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Long-term outcomes of ST-segment-elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from the EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION trial) trial was to compare 10-year outcomes of patients with ST-segment-elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient-oriented composite end point of all-cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient-oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05-1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19-2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow-up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13-2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST-segment-elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.
Collapse
Affiliation(s)
- Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Division of Cardiology University of Florida College of Medicine Jacksonville FL
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | - Simone Biscaglia
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Patrick W Serruys
- International Center of Circulatory Health Imperial College London London United Kingdom.,Department of Cardiology National University of Ireland Galway Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| |
Collapse
|
3
|
Gabani R, Spione F, Arevalos V, Grima Sopesens N, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Gender Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial. JACC Cardiovasc Interv 2022; 15:1965-1973. [PMID: 36008267 DOI: 10.1016/j.jcin.2022.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether gender plays a role in very long term outcomes. OBJECTIVES The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by gender. METHODS EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to gender. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. RESULTS Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. CONCLUSIONS At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and gender-specific risk factor control and targeted treatment. (10-Years Follow-Up of the EXAMINATION Trial [EXAMINAT10N]; NCT04462315).
Collapse
Affiliation(s)
- Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
| |
Collapse
|
4
|
Ascencio M, Munoz-Esquerre M, Pascual Y, Iglesias M, Sabater J, Murillo O, Sosa SG, Gomez-Hospital JA, Santos S, Comin-Colet J, Ferreiro JL. Impact of COVID-19 disease on platelet reactivity and association with inflammatory parameters. Eur Heart J 2021. [PMCID: PMC8767575 DOI: 10.1093/eurheartj/ehab724.3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic. Aside from the pulmonary manifestations, COVID-19 is associated with increased risk of venous and arterial thrombotic complications. The actual impact of SARS-CoV-2 infection on platelet reactivity and whether this is mediated by a hyperinflammatory status has not been fully elucidated to date. Objective To evaluate platelet reactivity in COVID-19 patients compared to healthy subjects and to assess the association between platelet reactivity and levels of inflammatory biomarkers among COVID-19 patients. Methods This prospective observational investigation included COVID-19 patients admitted into a tertiary care hospital and adult healthy volunteers, all of them not receiving any antiplatelet therapy. Subjects were classified in three groups: 1) Healthy subjects (HS group); 2) COVID-19 patients in a pulmonary phase (viral pneumonia and bilateral infiltrates) but without meeting criteria for systemic hyperinflammation (C19-Pulm group); and 3) COVID-19 patients in a hyperinflammation phase (C19-Infl group) meeting at least 2 of the following criteria: CRP>100mg/l, D-dimer >1000mcg/l, LDH>400U/l, ferritin>1000ng/ml, IL-6>70ng/l. Blood samples for platelet function testing and quantification of inflammatory parkers were collected at a single visit. Platelet function was measured with multiple electrode aggregometry using ADP (MEA-ADP, primary endpoint), arachidonic acid (AA) and thrombin receptor activating peptide (TRAP) as stimuli. Unadjusted analyses are presented. Results A total of 60 patients were included in the present investigation (20 in each group). A significantly greater platelet reactivity, measured with MEA-ADP, was observed in both groups of COVID-patients compared to healthy subjects (HS: 634,9±53,5, C19-Pulm: 919,9±53,5 and C19-Infl: 931,6±53,5 AU*min; p for C19-Pulm vs. HS <0,001, p for C19-Infl vs. HS <0,001, p for C19-Pulm vs. C19-Infl 0,878; Figure 1). Parallel findings were found when using AA as stimulus for platelet aggregation showing greater platelet aggregation in COVID-19 patients compared to healthy subjects, but numerical differences were not statistically significant when using TRAP. Among COVID-19 patients, when stratified by IL-6 levels splitted into tertiles, greater platelet reactivity was observed in patients with higher IL-6 concentrations (mid and upper tertile together) compared to those with values in the lower tertile, as assessed with MEA-ADP (lower tertile: 829,0±75,8, mid and upper tertile: 1028,7±56,2; p=0,043); a similar trend was observed with AA and TRAP as stimuli. Conclusion Patients with severe COVID-19 disease have greater platelet reactivity than healthy subjects. Increased IL-6 levels might be associated with the observed heightened platelet reactivity among COVID-19 patients. Funding Acknowledgement Type of funding sources: None.
Figure 1 ![]()
Collapse
Affiliation(s)
- M Ascencio
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| | - M Munoz-Esquerre
- University Hospital of Bellvitge, Department of Respiratory Medicine, Hospitalet De Llobregat, Spain
| | - Y Pascual
- University Hospital of Bellvitge, Department of Respiratory Medicine, Hospitalet De Llobregat, Spain
| | - M Iglesias
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| | - J Sabater
- University Hospital of Bellvitge, Department of Intensive Care Medicine, Hospitalet De Llobregat, Spain
| | - O Murillo
- University Hospital of Bellvitge, Department of Infectious Diseases, Hospitalet De Llobregat, Spain
| | - S G Sosa
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| | - J A Gomez-Hospital
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| | - S Santos
- University Hospital of Bellvitge, Department of Respiratory Medicine, Hospitalet De Llobregat, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| | - J L Ferreiro
- University Hospital of Bellvitge, Department of Cardiology, Hospitalet De Llobregat, Spain
| |
Collapse
|
5
|
Faroux L, Lhermusier T, Vincent F, Nombela-Franco L, Tchétché D, Barbanti M, Abdel-Wahab M, Windecker S, Auffret V, Campanha-Borges DC, Fischer Q, Muñoz-Garcia E, Trillo-Nouche R, Jorgensen T, Serra V, Toggweiler S, Tarantini G, Saia F, Durand E, Donaint P, Gutierrez-Ibanes E, Wijeysundera HC, Veiga G, Patti G, D'Ascenzo F, Moreno R, Hengstenberg C, Chamandi C, Asmarats L, Hernandez-Antolin R, Gomez-Hospital JA, Cordoba-Soriano JG, Landes U, Jimenez-Diaz VA, Cruz-Gonzalez I, Nejjari M, Roubille F, Van Belle É, Armijo G, Siddiqui S, Costa G, Elsaify S, Pilgrim T, le Breton H, Urena M, Muñoz-Garcia AJ, Sondergaard L, Bach-Oller M, Fraccaro C, Eltchaninoff H, Metz D, Tamargo M, Fradejas-Sastre V, Rognoni A, Bruno F, Goliasch G, Santaló-Corcoy M, Jimenez-Mazuecos J, Webb JG, Muntané-Carol G, Paradis JM, Mangieri A, Ribeiro HB, Campelo-Parada F, Rodés-Cabau J. ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2187-2199. [PMID: 33926655 DOI: 10.1016/j.jacc.2021.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. METHODS This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries. RESULTS Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk. CONCLUSIONS STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Flavien Vincent
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Marco Barbanti
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | | | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | | | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Erika Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | - Vicens Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Francesco Saia
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Pierre Donaint
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Gabriela Veiga
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | - Uri Landes
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Ignacio Cruz-Gonzalez
- University Hospital Salamanca, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, France
| | - Éric Van Belle
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Giuliano Costa
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Sameh Elsaify
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Hervé le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Antonio Jesus Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | | | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Damien Metz
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Andrea Rognoni
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Jean-Michal Paradis
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
| |
Collapse
|
6
|
Brugaletta S, Gomez-Lara J, Ortega-Paz L, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Mainar V, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, De Miguel-Castro A, Iñiguez A, Serra A, Nombela-Franco L, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Rodriguez-Arias JJ, Al-Shaibani S, Arevalos V, Romaguera R, Gomez-Hospital JA, Serruys PW, Sabaté M. 10-Year Follow-Up of Patients With Everolimus-Eluting Versus Bare-Metal Stents After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2021; 77:1165-1178. [PMID: 33663733 DOI: 10.1016/j.jacc.2020.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Outcomes data for a durable-polymer everolimus-eluting stent (EES) at extended long-term follow-up in patients with ST-segment elevation myocardial infarction (STEMI) are unknown. OBJECTIVES The aim of this study was to assess the 10-year outcomes of patients enrolled in the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial. METHODS The EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION Trial) study is an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly assigned 1,498 patients with STEMI in a 1:1 ratio to receive either EES (n = 751) or bare-metal stents (n = 747). The primary endpoint was a patient-oriented composite endpoint of all-cause death, any myocardial infarction, or any revascularization. Secondary endpoints included a device-oriented composite endpoint of cardiac death, target vessel myocardial infarction, or target lesion revascularization; the individual components of the combined endpoints; and stent thrombosis. RESULTS Complete 10-year clinical follow-up was obtained in 94.5% of the EES group and 95.9% of the bare-metal stent group. Rates of the patient-oriented composite endpoint and device-oriented composite endpoint were significantly reduced in the EES group (32.4% vs. 38.0% [hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.96; p = 0.013] and 13.6% vs. 18.4% [hazard ratio: 0.72; 95% confidence interval: 0.55 to 0.93; p = 0.012], respectively), driven mainly by target lesion revascularization (5.7% vs. 8.8%; p = 0.018). The rate of definite stent thrombosis was similar in both groups (2.2% vs. 2.5%; p = 0.590). No differences were found between the groups in terms of target lesion revascularization (1.4% vs. 1.3%; p = 0.963) and definite or probable stent thrombosis (0.6% vs. 0.4%; p = 0.703) between 5 and 10 years. CONCLUSIONS At 10-year follow-up, EES demonstrated confirmed superiority in combined patient- and device-oriented composite endpoints compared with bare-metal stents in patients with STEMI requiring primary percutaneous coronary intervention. Between 5- and 10-year follow-up, a low incidence of adverse cardiovascular events related to device failure was found in both groups. (10-Years Follow-Up of the EXAMINATION Trial; NCT04462315).
Collapse
Affiliation(s)
- Salvatore Brugaletta
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Luis Ortega-Paz
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Juan Jose Rodriguez-Arias
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Victor Arevalos
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabaté
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Spain
| |
Collapse
|
7
|
Lugo Gavidia L, Vivas D, De La Hera JM, Tello-Montoliu A, Marcano AL, Besteiro A, Silva I, Gomez-Polo JC, Playan J, Gomez-Hospital JA, Cequier A, Marin F, Roldan I, Ferreiro JL. 255Impact of the type of acute coronary syndrome on the pharmocodynamic response to P2Y12 inhibitors in the acute and maintenance phase of therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The presence of an acute coronary syndrome (ACS) is per se a predictor of reduced responsiveness to clopidogrel; in particular, patients with ST-elevation myocardial infarction (STEMI) have impaired clopidogrel-induced platelet inhibition than those with other forms of ACS. However, the impact of the type of ACS on the pharmocodynamic efficacy of more potent P2Y12 antagonists such as prasugrel or ticagrelor has not been fully elucidated to date.
Purpose
To assess the impact of the type of ACS on platelet inhibition mediated by P2Y12 receptor antagonists in the acute and the maintenance phase of therapy in a contemporary cohort of ACS patients undergoing percutaneous coronary intervention (PCI).
Methods
Substudy of a prospective, national, multicentre, pharmacodynamic registry conducted in a population of ACS patients undergoing PCI and treated with dual antiplatelet therapy including aspirin and a P2Y12 inhibitor as per clinical indication. Patients were classified according to the ACS diagnosis into groups: a) STEMI, b) non-ST-elevation ACS (NSTEACS), c) unstable angina (UA), and d) other (excluded from the present analysis). Platelet function tests (PFT) were performed at day 1 and day 30 (±5) after PCI and included: 1) VerifyNow P2Y12 assay, expressed as P2Y12 reaction units (PRUs); 2) Vasodilator-stimulated phosphoprotein (VASP) assay; and 3) Multiple electrode aggregometry (MEA).
Results
A total of 965 patients (372 with STEMI, 395 with NSTEACS and 198 with UA) were included in the present substudy. At day 1, the proportions of patients with each type of ACS according to the P2Y12 inhibitor received were: 1) clopidogrel (n=317): STEMI 35.0%, NSTEACS 34.4% and UA 30.6%; 2) prasugrel (n=192): STEMI 70.3%, NSTEACS 17.7% and UA 12.0%; 3) ticagrelor (n=456): STEMI 27.6%, NSTEACS 55.3% and UA 17.1%. A statistically significant reduced platelet inhibition, measured with the VerifyNow system, was observed in STEMI patients compared with the other forms of ACS in patients receiving clopidogrel (STEMI: 217.3±8.1, NSTEACS: 157.1±7.9 and UA: 164.9±8.6 PRUs; p for STEMI vs. NSTEACS <0.001 and p for STEMI vs. UA <0.001) and ticagrelor (STEMI: 57.7±3.8, NSTEACS: 45.2.1±2.6 and UA: 40.6±4.9 PRUs; p for STEMI vs. NSTEACS 0.008 and p for STEMI vs. UA 0.007), while a numerical trend towards greater platelet reactivity in STEMI compared to UA was observed in subjects receiving prasugrel (Figure). Remarkably, at day 30, no significant differences on platelet inhibition were observed according to the ACS type with any of the P2Y12 inhibitors. Similar results were observed with MEA and VASP assays.
PD response according to the ACS type
Conclusions
Patients presenting with STEMI have impaired platelet inhibition mediated by P2Y12 antagonists compared to other types of ACS during the acute phase of therapy, whereas no difference is observed during the maintenance phase of treatment.
Acknowledgement/Funding
Funded by Instituto de Salud Carlos III through the project PI13/01012 (co-funded by European Regional Development Fund. ERDF, a way to build Europe)
Collapse
Affiliation(s)
- L Lugo Gavidia
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| | - D Vivas
- Hospital Clinic San Carlos, Department of Cardiology, Madrid, Spain
| | - J M De La Hera
- University Hospital Central de Asturias, Department of Cardiology, Oviedo, Spain
| | - A Tello-Montoliu
- University Hospital Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain
| | - A L Marcano
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| | - A Besteiro
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| | - I Silva
- University Hospital Central de Asturias, Department of Cardiology, Oviedo, Spain
| | - J C Gomez-Polo
- Hospital Clinic San Carlos, Department of Cardiology, Madrid, Spain
| | - J Playan
- Hospital Clinic San Carlos, Department of Cardiology, Madrid, Spain
| | - J A Gomez-Hospital
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| | - A Cequier
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| | - F Marin
- University Hospital Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain
| | - I Roldan
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J L Ferreiro
- Bellvitge University Hospital - IDIBELL, Heart Diseases Institute, Hospitalet de Llobregat (L'), Spain
| |
Collapse
|
8
|
Hernandez JDLT, Camarero TG, Gomez-Hospital JA, Baz Alonso JA, Lizarbe SG, Alonso LG, Alfonso F, Ferrer GR, Recalde AS, Lee DH, Laso FS, Perez de Prado A, Hernandez F, Veiga G, Lozano I, Ongay AG, Zueco J. TCT-54 The Application of Predefined Optimization Criteria for Intravascular Ultrasound Guidance of Left Main Coronary Artery Stenting Improves Outcomes. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Núñez-Gil IJ, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, de la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez-Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Bagur R, Ugo F, Medda M, Louka BF, Kala P, Escaned J, Bautista D, Feltes G, Salinas P, Alkhouli M, Macaya C, Fernández-Ortiz A. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR). Int J Cardiol 2019; 299:49-55. [PMID: 31378382 DOI: 10.1016/j.ijcard.2019.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
Collapse
Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Mario Bollati
- Interventional Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Belén Terol
- Cardiology Department, Hospital Severo Ochoa, Leganés, Spain
| | | | | | - Pedro A Villablanca
- Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; University of Oviedo, Oviedo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Benjamín Camacho
- Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Marco Pavani
- Cardiology, Città della Salute e della Scienza, Molinnette II, Torino, Italy
| | - Juan Albistur
- Cardiology, Hospital de Clínicas Dr, Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Emodinamica, Azienda Ospedaliera Universitaria Policlinico "P,Giaccone" Palermo, Italy
| | - Massimo Mancone
- Is Sapienza University of Rome, Policlinico Umberto I. Department of Cardiovascular, Respiratory, Neurological, Anaesthesiology and Geriatric Sciences
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Alfonso Ielasi
- Cardiology Division, ASST Bergamo Est, Bolognini Hospital Seriate, Italy
| | - Íñigo Lozano
- Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | - Pierluigi Omedè
- Cardiology, Città della Salute e della Scienza, Molinnette I, Torino, Italy
| | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fabrizio Ugo
- Interventional Cardiology, H San Giovanni Bosco, Turin, Italy
| | - Massimo Medda
- Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, USA
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Bautista
- Cardiology, Instituto dominicano de Cardiología, Santo Domingo, Dominican Republic
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Mohamad Alkhouli
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | |
Collapse
|
10
|
Romaguera R, Gomez-Lara J, Gomez-Hospital JA. Letter by Romaguera et al Regarding Article, "Newer Generation Ultrathin Strut Drug-Eluting Stents Versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease: Meta-Analysis of Randomized Trials". Circulation 2019; 139:2081-2082. [PMID: 31013115 DOI: 10.1161/circulationaha.118.038410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rafael Romaguera
- Heart Diseases Institute, Hospital de Bellvitge - IDIBELL (Institut d'Investigació Biomédica de Bellvitge), University of Barcelona, Spain
| | - Josep Gomez-Lara
- Heart Diseases Institute, Hospital de Bellvitge - IDIBELL (Institut d'Investigació Biomédica de Bellvitge), University of Barcelona, Spain
| | - Joan Antoni Gomez-Hospital
- Heart Diseases Institute, Hospital de Bellvitge - IDIBELL (Institut d'Investigació Biomédica de Bellvitge), University of Barcelona, Spain
| |
Collapse
|
11
|
Vilalta V, Leor OR, Linares J, Ferrer GR, Carrillo X, Fernández-Nofrerias E, Ferreiro JL, Gomez-Hospital JA, Mauri J, Cequier A, Bayes-Genis A. TCT-293 Incidence, procedural aspects and prognosis of percutaneous coronary intervention of Unprotected Left Main Coronary Artery disease in patients with ST-segment elevation Myocardial Infarction. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Brugaletta S, Lara JG, Caballero-Borrego J, Ortega-Paz L, Gila LT, Jimenez M, Romaguera R, Martinez VA, Ñato M, Molina E, Gomez-Hospital JA, Vilchez CC, Cequier A, Sabate M. TCT-168 TIcaGrEloR and ABSORB Bioresorbable Vascular Scaffold implantation for recovery of vascular function after successful Chronic Total Occlusion recanalization. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Hernandez F, Bermudez EP, Molina E, Diaz J, Gutierrez H, Salvatella N, Carrillo X, Zueco J, Gomez-Hospital JA, Iñiguez A, Urbano Carrillo CA, Canas da Silva P, Perez de Prado A, Salinas P, Fores JS, Rumoroso J, Pinon P, Avanzas P, Lopez Minguez JR, Masotti M, Torres A, Moreno R, Lozano I, Bassaganyas J, Alonso Briales JH, Oteo Dominguez JF, Costa J, Andraka L, Serra A, Garcia B, Santos R, Ribeiro VG, Martins D, Hernandez JDLT. TCT-803 Safety and efficacy of bioresorbable coronary devices in clinical practice: 1-year final results from the multicenter prospective REPARA registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Di Marco A, Anguera I, Teruel L, Muntane G, Campbell NG, Fox DJ, Brown B, Skene C, Davidson N, Leon V, Dallaglio P, Elzein H, Garcia-Romero E, Gomez-Hospital JA, Cequier A. Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies. J Cardiovasc Electrophysiol 2017; 28:1169-1178. [DOI: 10.1111/jce.13290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/08/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Di Marco
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Ignasi Anguera
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Luis Teruel
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Guillem Muntane
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Niall G. Campbell
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - David J. Fox
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Benjamin Brown
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Chris Skene
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Neil Davidson
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Valentina Leon
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Paolo Dallaglio
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Hind Elzein
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | | | | | - Angel Cequier
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| |
Collapse
|
15
|
brugaletta S, Gori T, Low A, Tousek P, Bermudez EP, Lara JG, Ortega-Paz L, Schulz E, Chan M, Kocka V, Hurtado J, Gomez-Hospital JA, Muenzel T, Lee CH, Cequier A, Valdes M, Widimsky P, Serruys P, Sabate M. TCT-404 ABSORB bioresorbable vascular scaffold vs. everolimus-eluting metallic stent in ST-segment elevation myocardial infarction (BVS EXAMINATION study): 2-year results from a propensity score matched comparison. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Brugaletta S, Gori T, Low AF, Tousek P, Pinar E, Gomez-Lara J, Ortega-Paz L, Schulz E, Chan MY, Kocka V, Hurtado J, Gomez-Hospital JA, Giacchi G, Münzel T, Lee CH, Cequier A, Valdés M, Widimsky P, Serruys PW, Sabaté M. ABSORB bioresorbable vascular scaffold vs. everolimus-eluting metallic stent in ST-segment elevation myocardial infarction (BVS EXAMINATION study): 2-Year results from a propensity score matched comparison. Int J Cardiol 2016; 214:483-4. [PMID: 27096965 DOI: 10.1016/j.ijcard.2016.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Salvatore Brugaletta
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Tommaso Gori
- Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Mainz, Germany
| | - Adrian F Low
- Cardiac Department, National University Heart Centre Singapore, National University Health System, Singapore
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Eduardo Pinar
- Cardiology Department, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Josep Gomez-Lara
- Institute of Cardiology, Hospital of Bellvitge, Barcelona, Spain
| | - Luis Ortega-Paz
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Eberhard Schulz
- Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Mainz, Germany
| | - Mark Y Chan
- Cardiac Department, National University Heart Centre Singapore, National University Health System, Singapore
| | - Viktor Kocka
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jose Hurtado
- Cardiology Department, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | | | - Giuseppe Giacchi
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Thomas Münzel
- Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Mainz, Germany
| | - Chi-Hang Lee
- Cardiac Department, National University Heart Centre Singapore, National University Health System, Singapore
| | - Angel Cequier
- Institute of Cardiology, Hospital of Bellvitge, Barcelona, Spain
| | - Mariano Valdés
- Cardiology Department, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Manel Sabaté
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| |
Collapse
|
17
|
Romaguera R, Gómez-Lara J, Jacobi F, Gomez-Hospital JA, Cequier A. Polymer-free amphilimus-eluting stents in patients with diabetes mellitus. Minerva Cardioangiol 2014; 62:421-426. [PMID: 25295493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite several improvements in drug-eluting stents design, diabetes mellitus (DM) remains an Achilles' heel for percutaneous coronary revascularization at the present time. The Cre8 stent is a third-generation drug-eluting stent devoid of polymer. The drug, which is formulated with an amphiphilic carrier, is eluted from laser-dug wells on the stent's abluminal surface. The Cre8 stent hat has shown promising preliminary results in patients with DM. This review summarizes the mechanisms of DES failure in patients with DM and the potential role of the Cre8 stent in this high-risk population.
Collapse
Affiliation(s)
- R Romaguera
- Heart Diseases Institute Hospital de Bellvitge‑IDIBELL University of Barcelona, Barcelona, Spain -
| | | | | | | | | |
Collapse
|
18
|
Ariza-Solé A, Salazar-Mendiguchía J, Lorente V, Sánchez-Salado JC, Ferreiro JL, Romaguera R, Ñato M, Gomez-Hospital JA, Cequier Á. Body mass index and acute coronary syndromes: Paradox or confusion? European Heart Journal: Acute Cardiovascular Care 2014; 4:158-64. [DOI: 10.1177/2048872614534080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | | | | | | | - Marcos Ñato
- Cardiology Department, Bellvitge University Hospital, Spain
| | | | - Ángel Cequier
- Cardiology Department, Bellvitge University Hospital, Spain
| |
Collapse
|
19
|
Gomez Lara J, Brugaletta S, Cequier A, Gomez-Hospital JA, Sabate M. TCT-213 Everolimus-eluting stent versus bare metal stent in proximal left anterior descending ST-elevation myocardial infarction. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Gomez Lara J, Cequier A, Gomez-Hospital JA, Romaguera R, Roura G. TCT-386 Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Gomez Lara J, Teruel L, Homs S, Ferreiro JL, Romaguera R, Roura G, Sánchez-Elvira G, Brugaletta S, Gomez-Hospital JA, Cequier A. TCT-75 Lumen Enlargement of the Coronary Segments Located Distal to Chronic Total Occlusions Successfully Treated with Drug-Eluting Stents at Follow-up. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Romaguera R, Gomez-Hospital JA, Cequier A. Novel use of the Mguard™ mesh-covered stent to treat coronary arterial perforations. Catheter Cardiovasc Interv 2012; 80:75-8. [DOI: 10.1002/ccd.23506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/08/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022]
|
23
|
Romaguera R, Gomez-Hospital JA, Sanchez-Elvira G, Gomez-Lara J, Roura G, Ferreiro JL, Homs S, Teruel L, Jara F, Cequier A. Thrombus aspiration plus Mguard mesh covered stent for treatment of ST-segment elevation myocardial infarction. Cardiovascular Revascularization Medicine 2012. [DOI: 10.1016/j.carrev.2012.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
24
|
Romaguera R, Sánchez-Elvira G, Gomez-Hospital JA, Gomez-Lara J, Ferreiro JL, Roura G, Homs S, Jara F, Teruel LM, Cequier A. MGUARD MESH-COVERED STENT FOR TREATMENT OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH HIGH THROMBUS BURDEN DESPITE MECHANICAL ASPIRATION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Vaquerizo B, Serra A, Miranda-Guardiola F, Martinez V, Gomez-Hospital JA, Cequier A, Iniguez A, Baz JA, Bastos G, Fernandez E, Rodriguez O, Mauri J, Sabada M, Rumoroso JR, Subinas A, Garcia-Borbolla R, Gomez A, Oneto J, Martinez A, Bossa F, Moreno R, Saez A, Otaegui I, Garcia B, Angel J. 7-MONTHS FOLLOW-UP OF DRUG ELUTING STENT RESTENOSIS TREATED BY DRUG ELUTING BALLOON: PROSPECTIVE AND MULTICENTER REGISTRY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Manito N, Kaplinsky EJ, Roca J, Castells E, Saura E, Gomez-Hospital JA, Esplugas E. Heart transplant recipient clinical profile improvement following mycophenolate mofetil late incorporation into the treatment schedule. Clin Transplant 2005; 19:304-8. [PMID: 15877789 DOI: 10.1111/j.1399-0012.2005.00238.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mycophenolate mofetil (MMF) has a better clinical profile than azathioprine in heart transplantation (HT). Forty-five recipients (aged 53 +/- 9 yr) were retrospectively evaluated (first year of follow-up) post-MMF introduction since its advent in 1997 (mean daily dose: 1.97 +/- 0.2 g). MMF was used (mean post-HT time: 40 +/- 27 months) for: (i) renal insufficiency attenuation (group 1 = 20); (ii) steroid reduction because of osteoporosis (group 2 = 12); (iii) treatment of persistent cellular rejection (group 3 = 7) and vascular graft disease (VGD) (group 4 = 6). Mean changes (groups 1-2) were: creatinine 172 +/- 59, 158 +/- 51, 153 +/- 57 mumol/L (at baseline, 6 and 12 months, respectively; p < 0.001). Cyclosporine daily dose: 219 +/- 37, 166 +/- 46, 176 +/- 98 mg, respectively (p < 0.001). Cyclosporine blood concentration: 151 +/- 40, 103 +/- 41, 83 +/- 34 ng/mL, respectively (p < 0.004). Prednisone daily dose: 8.3 +/- 2, 5.2 +/- 1, 4.1 +/- 1 mg, respectively (p < 0.001). Cellular rejection (group 3) was successfully treated (86%) but the outcome of VGD did not improve after the switch (group 4). Our limited experience (with caution) confirms the reported benefits of MMF particularly attenuating renal insufficiency.
Collapse
Affiliation(s)
- Nicolás Manito
- Heart Transplant Unit, Bellvitge Hospital, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
27
|
Kaplinsky EJ, Manito N, Roca J, Castells E, Saura E, Gomez-Hospital JA, Caldés A, Esplugas E. Sirolimus in heart transplantation: a single center initial experience. Transplant Proc 2003; 35:1978-80. [PMID: 12962868 DOI: 10.1016/s0041-1345(03)00658-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sirolimus (SRL) is a potent non-nephrotoxic immunosuppressant. In our unit, SRL was administered to 17 heart transplant (HT) recipients at 1770+/-1234 days' posttransplant surgery, for the following reasons: (1) calcineurin inhibitor (CI) withdrawal due to renal insufficiency (RI; n=6); (2) neurotoxicity (n=1) and pancytopenia (n=1); (3) vascular graft disease (VGD) treatment (n=5); (4) immunosuppression optimization due to lung cancer (n=2); (5) CI use was delayed due to postsurgery RI (n=2). The mean follow-up was 190+/-165 days. Mean SRL doses (mg)/concentrations (ng/mL) at 7 (n=17), 30 (n=14), and 180 (n=8) days were: 1.2+/-0.6/5.9+/-6; 1.6+/-0.8/4.8+/-3.1; and 1.7+/-1.0/5.2+/-3.7. Among group 1, CI patients were discontinued without favorable functional impact. Neurotoxicity and pancytopenia improved, but there were no major clinical events in the VGD group. One "bridge" to CI was successfully performed (postsurgery RI). Total leukocyte count fell while hemoglobin, platelet, and cholesterol profiles were not affected. Ten of 15 patients (67%) were discontinued from CI without rejection and with a dose reduction of mycophenolate mofetil. There were 8 episodes (47%) of SRL-related toxicity, leading to 4 discontinuations (23%); 8 patients (47%) have died during follow-up. This retrospective analysis of outcomes in the context of severe complicated patients suggests that more premature introduction SRL is preferable, particularly in a large patient cohort.
Collapse
Affiliation(s)
- E J Kaplinsky
- Heart Transplant Unit, Bellvitge Universitari Hosptial, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Manito N, Perez JL, Roca J, Castells E, Niubó J, Garcia A, Ribas M, Saura E, Rufí G, Gomez-Hospital JA, Espinoza C, Esplugas E. Usefulness of quantitative cytomegalovirus antigenemia determinations in heart transplantation. Transplant Proc 1999; 31:2526-7. [PMID: 10500700 DOI: 10.1016/s0041-1345(99)00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- N Manito
- Servicio de Cardiología, Ciudad Sanitaria y Universitaria de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sabaté M, Manito N, Cequier A, Roca J, Mauri J, Jara F, Gomez-Hospital JA, Ruiz-Majoral A, Sala J, Alcaide P. Acute rejection, cytomegalovirus infection and endothelial dysfunction early after heart transplantation. Transplant Proc 1995; 27:2346-8. [PMID: 7652837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M Sabaté
- Department of Cardiology, Princeps D'Espanya Hospital, Central University of Barcelona, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|