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Benatar IF, Sa A, Sole E, Castel M, Caravaca P, Alvarez AG, Sandoval E, Marquez NI, Canto P, Rodriguez J, Cepas P, Sabate M, Casal J, Izquierdo L, Torrecilla E, Torres MF. Super Accelerated Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1225] [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: 04/05/2023] Open
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2
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Arevalos Rivas V, Spione F, Gabani R, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz VA, Jimenez M, Jimenez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Sabate M, Brugaletta S. Impact of age at the time of the first ST-elevation myocardial infarction on 10-year outcomes. A sub-analysis from the EXAMINATION EXTEND trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The aim of this post-hoc sub analysis of the EXAMINATION-EXTEND study was to analyze 10-year outcomes according to the age of the patient at the time of the first STEMI.
Methods
Out of 1498 STEMI patients included in the EXAMINATION-EXTEND study, those with a previous history of atherosclerotic cardiovascular disease (coronary ischemic event, ischemic stroke, or previous coronary revascularization) were excluded for this analysis. The remaining 1375 patients were divided into three age groups: <55, 55–65 and >65 years. The primary endpoint was 10-year patient oriented composite endpoint (POCE) of all-cause death, any myocardial infarction (MI), or any revascularization. Secondary endpoints included the individual components of the primary endpoint, cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR), and stent thrombosis. The association between age and endpoints was adjusted for baseline confounders.
Results
At 10-year follow-up, patients <55 years (Adjusted hazard ratio [HR]: 0.42, 95% CI: 0.33–0.53, p=0.001), and 55–65 years (Adjusted HR: 0.44, 95% IC: 0.35–0.56, p=0.001) showed lower risk of POCE compared with those >65 years, led by a lower incidence of all-cause death (<55: 5.8% vs. 55–65: 11.3% vs. >65 years: 40.67%, p=0.001). Cardiac death was more prevalent in the older group (<55: 3.5% vs. 55–65: 5.5% vs. >65 years: 21.3%, p=0.001). There were not significant differences in the incidence of TVMI, TLR and stent thrombosis among the different age groups. In the landmark analyses, between 5 and 10-year follow-up, young patients exhibited higher incidence of any revascularization (<55: 7.4% vs. 55–65: 4.9% vs. >65 years: 1.7%, p=0.001) and a trend towards a higher incidence of any MI (<55: 5.2% vs. 55–65: 3.6% vs. >65 years: 1.5%, p=0.064). No differences were found in any other endpoints.
Conclusions
In patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up, in particular, due to all-cause and cardiac death. Conversely, patients who presented at younger age exhibited a high risk of revascularization at long-term follow-up.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular
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Affiliation(s)
| | - F Spione
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - R Gabani
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - L Ortega-Paz
- University of Florida College of Medicine , Jacksonville , United States of America
| | - J Gomez-Lara
- University Hospital Bellvitge , Barcelona , Spain
| | | | - M Jimenez
- Sant Pau Hospital , Barcelona , Spain
| | | | - R Diletti
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - J Pineda
- General University Hospital of Alicante , Alicante , Spain
| | - G Campo
- University Hospital of Ferrara , Ferrara , Italy
| | | | - J Maristany
- Son Dureta University Hospital , Palma de Mallorca , Spain
| | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Brugaletta
- Hospital Clinic of Barcelona , Barcelona , Spain
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3
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Arevalos Rivas V, Ortega-Paz L, Fernandez-Rodriguez D, Jimenez-Diaz VA, Baneras Rius J, Campo G, Diaz JF, Scardino C, Rodriguez-Santamarta M, Gonzalo N, Perginotti A, Alfonso F, Amat-Santos I, Sabate M, Brugaletta S. Long-term effects of coronavirus disease 2019 on the cardiovascular system: the CV COVID-19 registry. Eur Heart J 2022. [PMCID: PMC9619707 DOI: 10.1093/eurheartj/ehac544.2859] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Patients with COVID-19 have an increased risk of cardiovascular adverse events during the acute phase. However, the long-term cardiovascular outcomes are unknown. Objective We aimed to determine the long-term effects of COVID-19 in the cardiovascular system. Methods This is a multicenter, observational, retrospective registry conducted at 17 centers in Spain and Italy. Consecutive patients older than 18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions were included. Patients were classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome was cardiovascular (CV) death at 1-year. The secondary outcomes included acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias at 1-year. Outcomes were compared between the two groups. An independent clinical event committee adjudicated events. Results A total of 4427 patients were included, 3578 (80.8%) patients with COVID-19 and 849 (19.2%) without COVID-19. COVID-19 patients were older, had a higher rate of classical cardiovascular risk factors, except for active smoking, and had fewer comorbidities. At a median time of 13.5 (IQR 11.8–15.8) months, after an adjustment by baseline characteristics, there was no difference in CV death (1.4% vs. 1.1%; HR 1.03 [0.49–2.18]; p=0.941) between patients with COVID-19 and without. However, COVID-19 patients experienced higher rate of venous thromboembolism (VTE) (3.9% vs. 0.6%, HR 6.11 [2.46–15.16]; p=0.001), major bleeding (2.9% vs. 0.5%, HR 5.38 [1.95–14.84]; p=0.001), and serious cardiac arrhythmias (2.6% vs. 0.9%, HR 2.25 [1.07–4.73]; p=0.033). During follow-up, between discharge and end of follow-up, COVID-19 patients did not experience a higher risk of adverse cardiovascular outcomes (composite of CV death, any MI, ischemic stroke, systemic arterial thrombosis, VTE, heart failure hospitalization, or any serious arrhythmia) compared to patients without (HR 0.80; [0.53–1.21]; p=0.298). Conclusions At 1-year follow-up, COVID-19 was not associated with an increased risk of cardiovascular death but with a higher risk of VTE events, major bleeding, and serious cardiac arrhythmias. COVID-19 was not associated with a higher risk of adverse cardiovascular events during follow-up. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Institute, Madrid, Spain
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Affiliation(s)
| | - L Ortega-Paz
- University of Florida College of Medicine , Jacksonville , United States of America
| | | | | | | | - G Campo
- University Hospital of Ferrara , Ferrara , Italy
| | - J F Diaz
- Hospital Juan Ramon Jimenez , Huelva , Spain
| | - C Scardino
- University Hospital of Taragona Joan XXIII , Tarragona , Spain
| | | | - N Gonzalo
- San Carlos Clinical University Hospital , Madrid , Spain
| | - A Perginotti
- Hospital de Tortosa Verge de la Cinta , Tarragona , Spain
| | - F Alfonso
- La Princesa University Hospital , Madrid , Spain
| | - I Amat-Santos
- University Hospital Clinic of Valladolid , Valladolid , Spain
| | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Brugaletta
- Hospital Clinic of Barcelona , Barcelona , Spain
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4
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Salamanca Viloria J, Garcia-Guimaraes M, Sabate M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizon H, Velazquez M, Veiga G, Bastante T, Alvarado T, Diez-Villanueva P, Alfonso F. Multivessel spontaneous coronary artery dissection: clinical features, angiographic findings, management, and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The rate of SCAD patients with multivessel (MV) involvement varies between series (6–13%)1,2. MV SCAD might be potentially associated to a worse prognosis due to a higher ischemic burden compared with patients with single-vessel (SV) involvement. However, comparative data between patients with MV versus SV SCAD is lacking.
Methods
The Spanish multicentre nationwide SCAD registry prospectively included 389 consecutive patients from 34 university hospitals. Patients were classified according to the number of affected vessels in two groups: SV or MV SCAD. In-hospital major adverse event (MAE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, cardiogenic shock, ventricular arrhythmia or stroke. A major cardiac or cerebrovascular adverse event (MACCE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, SCAD recurrence or stroke.
Results
A total of 41 patients (10.5%) presented MV SCAD (Table 1). There were no significant differences between groups regarding age, sex and distribution of most cardiovascular risk factors, with a non-significant trend towards more hypertension in the MV group (49% vs 34%, p=0.06). MV SCAD patients had more often previous history of hypothyroidism (22% vs 11%, p=0.04) and anxiety disorder (32% vs 16%, p=0.01), with a trend towards more fibromuscular dysplasia (50% vs 29%, p=0.12) among those patients screened. MV SCAD patients presented more often with NSTEMI (73% vs 52%, p=0.01). Regarding angiographic findings, MV SCAD patients presented more frequently focal type 3 lesions (19% vs 6%, p<0.01) and fewer type 1 double-lumen lesions (12% vs 21%, p=0.04). The rate of lesions with an impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0–1 was lower (14% vs 29%, p<0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p=NS). We found no significant differences between groups in MAE during admission. At long-term follow-up (median 29 months), there were no significant differences in MACCE between groups (18% vs 12%, p=0.28). However, the rate of stroke was higher in patients with MV SCAD, both in-hospital (2.4% vs 0%, p<0.01) and at follow-up (5.1% vs 0.6%, p=0.01). This finding could be explained by the basal differences found in hypertension and fibromuscular dysplasia between MV and SV SCAD patients.
Conclusions
Patients with MV SCAD have some distinctive clinical and angiographic features. We found no significant differences in our primary composite outcomes, both in-hospital and at long-term follow-up, between patients with SV and MV SCAD. Rate of stroke was significantly higher in patients with MV SCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - R Sanz-Ruiz
- Gregorio Maranon University General Hospital - Madrid Health Service , Madrid , Spain
| | - F Macaya
- Hospital Clinico San Carlos , Madrid , Spain
| | - G Roura
- University Hospital of Bellvitge , Barcelona , Spain
| | | | - J M Nogales
- University Hospital of Badajoz , Badajoz , Spain
| | - H Tizon
- Hospital del Mar , Barcelona , Spain
| | - M Velazquez
- University Hospital 12 de Octubre , Madrid , Spain
| | - G Veiga
- University Hospital Marques de Valdecilla , Santander , Spain
| | - T Bastante
- University Hospital La Princesa , Madrid , Spain
| | - T Alvarado
- University Hospital La Princesa , Madrid , Spain
| | | | - F Alfonso
- University Hospital La Princesa , Madrid , Spain
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5
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Gabani R, Spione F, Arevalos V, Ortega L, Brugaletta S, Grima Sopesens N, Sabate M, Gomez Lara J, Jimenez M, Jimenez Quevedo P. Gender differences on 10-year outcomes following ST-segment elevation myocardial infarction: a subgroup analysis from the examination extend trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Short-term outcomes of women following STEMI are worse than men, with specifically a higher mortality rate. However, it is unknown if gender may play a role in long-term outcomes. We aim to assess whether very long-term outcomes following STEMI treatment may be still influenced by gender.
Methods
The EXAMINATION-EXTEND study was an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly 1:1 assigned 1498 STEMI patients to receive either EES (n=751) or bare metal stent (BMS) (n=747). This is a sub-analysis of this study, according to gender. Primary endpoint was the composite patient-oriented endpoint (POCE, all-cause death, any myocardial infarction, or any revascularization) at 10-year. Secondary endpoints were individual components of the primary endpoint. All the endpoints were adjusted for age.
Results
Out of 1498 STEMI patient, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10-year, no difference was observed between women and men in terms of POCE (40.6% vs. 34.2%; adjusted hazard ratio (HR) 95% confidence interval [CI]1.14 [0.91–1.42], p=0.259). There was a trend toward a higher all-cause death in women vs. men (27.6%, vs. 19.4%; adjusted HR [95% CI] 1.30 [0.99–1.71], p=0.063), without difference in cardiac death. No differences were present in terms of the 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 towards a higher all-cause death in women. These findings may suggest that very long-term healthcare attention following STEMI in women should go beyond reduction of cardiac events.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Public hospital
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Affiliation(s)
- R Gabani
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | - F Spione
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | - V Arevalos
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | - L Ortega
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | - S Brugaletta
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | | | - M Sabate
- hospital clinic barcelona, hemodynamics , barcelona , Spain
| | - J Gomez Lara
- Bellvitge University Hospital , Hospitalet De Llobregat , Spain
| | - M Jimenez
- Sant Pau Hospital , Barcelona , Spain
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6
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De Diego Soler O, Sanabria A, Morr I, Alamar M, Lorenzatti D, Prat S, Doltra A, Millan I, Sotes S, Lopez T, Ortega-Paz L, Sabate M, Andrea R, Brugaletta S, Ortiz-Perez JT. Analysis of myocardial salvage with cardiac magnetic ressonance and angiography depending on the STEMI revascularization pathway in a PPCI centre. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Reperfusion networks have permitted improvements in reperfusion delays in primary percutaneous coronary intervention (PPCI)-treated ST elevation myocardial infarction (STEMI). However, the impact on myocardial salvage (MS) of direct transfer to the catheterization laboratory (cath-lab) to minimize system delay remains unknown.
Objective
We sought to quantify the myocardial salvage index (MSI) acutely and to assess adverse remodeling at 6 months in PPCI-treated STEMI according to the mode of patient presentation.
Methods
Between 2005 and 2021 we included 493 patients in a single center registry of first PPCI-treated STEMI who were studied with Late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) in the acute phase. Among them, 414 (84.0%) underwent a second LGE-CMR at 6 months. Subjects were classified depending on the mode of presentation: those diagnosed out-of-hospital and directly transferred to the cath-lab by the Emergency Medical Services (EMS group, 29.82%); subjects with first medical contact in a PCI-capable hospital (PCI-H group, 41.75%); and patients presenting to a non-PCI-capable center and transferred for PCI (non-PCI-H group, 28.43%). We computed the angiographic area at risk by BARI score, and combined it with the LGE-CMR derived infarct size to compute a validated MSI, expressed as percentage of area at risk. The change in ejection fraction (EF) and indexed left ventricle end-diastolic volume (iLVEDV) from baseline to 6 months was also computed.
Results
The mean age was 58.9±11.9 years, 84.5% were male and 51.4% had anterior STEMI. Total median ischaemic time was (median (interquartile range)) 126 (105–161) min in the EMS group, 201 (145–321) min in the PCI-H group and 300 (173–592) min in the non-PCI-H group (p<0.01). MSI was 45.28±2.6%, 39.63±2.2% and 35.53±2.7% respectively (p=0.034). In a multiple linear regression model adjusting for relevant covariables, including initial TIMI flow, area at risk, Killip class, age, sex, diabetes, number of vessels and presence of collaterals, a 7.50% (95% CI 0.9 to 14.1%) increase in MSI was observed in the EMS group compared to the PCI-H group, and 11.03% (95% CI 3.9 to 18.2%) compared to the non-PCI-H group (p=0.027 and 0.003 respectively). At 6 months, the mean absolute increase in EF was 5.36±0.6% for the EMS group, 4.03±0.5% for the PCI-H group and 3.52±0.6% for the non-PCI-H group (p<0.05 in the adjusted analysis) and the increase in iLVEDV was 2.37±7.3, 5.51±6.6 and 18.30±7.6 mL/m2 respectively (p=0.28).
Conclusions
Patients with out-of-hospital diagnostis of STEMI by the EMS who were directly transferred to the cath-lab showed shorter total ischaemic times, resulting in increased myocardial salvage and a trend towards improved indexes of left ventricular function at 6 months.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Grant from La Maratό de TV3 and grant from Fundaciό La Caixa
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Affiliation(s)
| | - A Sanabria
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - I Morr
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - M Alamar
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - D Lorenzatti
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Prat
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - A Doltra
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - I Millan
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Sotes
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - T Lopez
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - L Ortega-Paz
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - R Andrea
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - S Brugaletta
- Hospital Clinic of Barcelona , Barcelona , Spain
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7
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Vriesendorp PA, Wilschut JM, Diletti R, Daemen J, Kardys I, Zijlstra F, Van Mieghem NM, Bennett J, Esposito G, Sabate M, den Dekker WK. Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis. Neth Heart J 2022; 30:449-456. [PMID: 35536483 PMCID: PMC9474746 DOI: 10.1007/s12471-022-01687-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation.
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Affiliation(s)
- P A Vriesendorp
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
- The Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - J M Wilschut
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R Diletti
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - F Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - N M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - G Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M Sabate
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W K den Dekker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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8
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Gomez Monterrosas O, Martin Yuste V, Freixa X, Brugaletta S, Regueiro A, Masotti M, Sabate M. Long-term clinical outcomes of patients with chronic total coronary occlusion caused by intra-stent re-stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1199] [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
Objectives
In this study we aim 1) at identifying predictors of selecting percutaneous coronary intervention (PCI) to treat chronic total occlusion due to in-stent restenosis (CTO-ISR); and, 2) at comparing long-term clinical outcomes of patients treated with coronary artery by-pass graft (CABG), percutaneous coronary intervention (PCI) or optimal medical therapy (OMT).
Methods
Between June 2010 and January 2014 a total of 1290 CTO were included in a prospective Registry. 86 of those patients presented with CTO-ISR. Clinical follow-up was obtained until April 2019. Major adverse cardiac events (MACE) rate was defined as the composite end-point of cardiac death, acute myocardial infarction or target lesion revascularization (TLR).
Results
A total of 54 patients were treated with PCI (63%), 22 received OMT alone (25%) and the remaining 10 (12%) were treated with CABG. Patients treated with PCI were older and presented higher values of left ventricular ejection fraction than those of the other groups. From the anatomical point of view, calcification and ostial location were more frequently observed in the OMT group, whereas Syntax score was higher in the CABG arm. At multivariate analysis, age and Syntax score were the only independent predictors of selecting PCI. At long-term follow-up (mean 101 months), MACE rate was higher in the CABG arm mainly driven by a higher incidence of TLR.
Conclusions
Percutaneous coronary intervention could be an effective and safe procedure to treat CTO-ISR. Larger prospective trials are required to confirm these clinical results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - X Freixa
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | - S Brugaletta
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | - A Regueiro
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | - M Masotti
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | - M Sabate
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
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9
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Jimenez Britez G, Freixa X, Sabate M, Diaz M, Hernandez-Enriquez M. Optimal antiplatelet therapy in out-hospital cardiac arrest with mild therapeutic hypothermia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Out-of-Hospital Cardiac Arrest (OHCA) and Mild therapeutic hypothermia (MTH) has been linked to an increased risk of Stent Thrombosis (ST) in comatose survivors who underwent percutaneous coronary intervention (PCI). There is no formal recommendation about which antiplatelet regimen should be used in patients with Acute Coronary Syndrome (ACS) after OHCA
Methods
Prospective, single center study.
We compared antiplatelet efficacy of clopidogrel and ticagrelor at different time points after primary PCI in OHCA patients underwent MTH with 2 systems (VerifyNow®) and light transmission aggregometry.
With the system (VerifyNow®) the results were expressed in P2Y12 reaction units (PRU) in response to ADP-prostaglandin E1.
With the aggregometry in vitro platelet aggregation was measured in response to ADP (20 lmol/L at 37 C). The main result was the percentage of maximal platelet aggregation
Results
24 consecutive OHCA patients were included in our hospital.
We confirmed that residual platelet activity was higher with clopidogrel than with ticagrelor, expressed by PRU, 2 h after loading dose (229±56 vs. 180±30, p<0.014), 6h after loading dose during MTH (203±45 vs. 135±51, p<0.004), 24h after loading dose during MTH (188±52 vs. 58±64, p<0.0001), after warming (200±55 vs. 27±24, p<0.0001) and 24 h after warming (201±57 vs. 31±24, p<0.0001).
With the aggregometry we observed higher percentajes of maximal platelet aggregation in response to ADP with clopidogrel than ticagrelor since 6 hs after loading dose. 2 h after loading dose (44±17 vs. 36±23, p: 0.439), 6h after loading dose during MTH (42±13 vs. 24±20, p<0.02), 24h after loading dose during MTH (26±20 vs. 9.5±6.5, p<0.005), after warming (26±16 vs. 12±8, p<0.02)..
Conclusion
In this study, we observed a lower antiplatelet efficacy of clopidogrel compared with ticagrelor in patients with OHCA after PCI with MHT. This decrease in antiplatelet efficacy persists after the warming. Similarly to other settings, ticagrelor might be a valid alternative to clopidogrel in those patients
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministerio de Economía y Competitividad. Instituto Carlos III, Fondo Investigaciόn Sanitaria. Spain
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Affiliation(s)
| | - X Freixa
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - M Diaz
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
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10
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Calvo M, Guzman J, Perez P, Ortega L, Mendieta G, Lorenzatti D, Perez N, Gavara J, Marcos Garces V, Brugaletta S, Sabate M, Bodi V, Ortiz Perez J. Complete revascularization of non-culprit lesions in stemi is associated with improved myocardial salvage and reduced microvascular obstruction: a cardiac magnetic resonance study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COMPLETE trial showed that routine and complete Percutaneous Coronary Intervention (PCI) of non-infarct related artery (non-IRA) lesions in STEMI was associated with a significant reduction in the rates of death or new myocardial infarction. However, whether this benefit is related to improved myocardial salvage and left ventricular (LV) function is unknown.
Methods
We prospectively included 465 patients with first STEMI reperfused by primary PCI. Late gadolinium-enhanced Cardiac Magnetic Resonance (CMR) was obtained during admission to measure the area at risk (AAR), IRA-infarct size (IS) as % LV mass, and myocardial salvage index (MSI) as % of AAR. The study was repeated in 392 of them at 6 months follow-up to compute LV volumes and ejection fraction (EF).
Results
Patients with three-vessel disease had larger IS than those with two or single vessel disease (25.4±14.5% vs 19.0±13.1% vs 19.0±12.8% LV mass respectively, p<0.05), despite no differences in AAR (33±11% LV mass for all). Accordingly, MSI decreased progressively for one, two or three-vessel disease (42.4±31.4 vs 41.5±30.6 vs 25.1±31.3% AAR respectively, p<0.01). The number of myocardial segments with microvascular obstruction (MVO) was also higher for three-vessel disease (1.9±1.9) than for two (1.1±1.7) or single-vessel disease (1.2±1.8), p<0.05. Mean follow-up EF also decreased progressively with the number of vessels involved (50.7±9.4, 49.1±11.4 and, 44.4±11.2% respectively, p<0.01). A total of 183 patients had multivessel disease. Among them, those with complete revascularization (n=51) had larger MSI (46.4±35.2 vs 34.5±29.3% AAR, p<0.04) and were less likely to have MVO phenomenon (28.6 vs 49.2%, p<0.05). However, no significant differences in the change in EF was observed between both groups (ΔEF:+4.4±6.2 vs +4.3±6.2%, p=0.985 for the interaction).
Conclusion
The presence and extent of multivessel disease influence myocardial salvage and MVO following primary PCI in STEMI. Improvement in myocardial salvage in the IRA territory and a reduction in microvascular obstruction may mediate the beneficial effects of complete revascularization.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Marato TV3 2015303132, FIS PI15/00531. Partially funded with FEDER funds.
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Affiliation(s)
- M Calvo
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - J Guzman
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - P Perez
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - L.G Ortega
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - G Mendieta
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - D Lorenzatti
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Marcos Garces
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - S Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - M Sabate
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - V Bodi
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J.T Ortiz Perez
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
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11
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Echarte Morales J, Cepas Guillen P, Caldentey G, Martinez Gomez E, Borrego-Rodriguez J, Vidal P, Llagostera M, Viana Tejedor A, Benito Gonzalez T, Flores-Umanzor E, Quiroga X, Perez De Prado A, Freixa X, Sabate M, Fernandez-Vazquez F. Outcomes of nonagenarians with acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials.
Objective
The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management.
Methods
We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed.
Results
523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03).
Conclusion
An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | | | - P Vidal
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - X Freixa
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
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12
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Vidal P, Cepas Guillen P, Caldentey G, Martinez Gomez E, Borrego-Rodriguez J, Echarte Morales J, Minguito Carazo C, Alonso Orcajo N, Llagostera M, Castillo M, Viana Tejedor A, Quiroga X, Freixa X, Fernandez-Vazquez F, Sabate M. Acute coronary syndromes in nonagenarians: do we have reliable risk scores? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
GRACE score is strongly validated to determine the probability of death in acute coronary syndrome (ACS), nevertheless its usefulness in nonagenarians, a population with frequently associated comorbidities, is less stablished. BARTHEL and CHARLSON scores might be useful tools to predict outcomes in this population.
Objective
The aim of this study was to evaluate the potential applicability of GRACE score and two comorbidity scores (CHARLSON and BARTHEL) to estimate prognosis in nonagenarians with ACS.
Material and methods
We retrospectively included all consecutive patients equal to or older than 90 years old admitted with non-ST (NSTEMI) or ST segment elevation myocardial infarction (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristics and procedural data. In-hospital and at 1-year follow-up all-cause and cardiovascular mortality were assessed. Risk score accuracy was evaluated by area under the curve ROC (AUC).
Results
A total of 444 patients (mean age 92.6±2.4 years, 60% females) were analyzed.
Approximately half of them (n=241, 54%) with STEMI and the remainder (n=203, 46%) with NSTEMI. Global GRACE-AUC for in-hospital and 1-year all-cause mortality were moderate (0.64; 95% CI: 0.59–0.69 and 0.62; 95% CI: 0.57–0.67, respectively). Only in the NSTEMI group, the GRACE-AUC was better to predict in-hospital mortality, 0.70 (95% CI: 0.63–0.77). Neither CHARLSON nor BARTHEL showed better predictive results than GRACE score (AUC ≤0.60).
Conclusion
GRACE score has moderate accuracy to estimate mortality in nonagenarian patients with ACS. BARTHEL and CHARLSON scores do not improve the predictive value of GRACE score. An individualized approach is required to make therapeutic decisions in this special population.
Figure 1. ROC-GRACE curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Vidal
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - M Castillo
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - X Freixa
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
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13
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Serruys PWJC, Walsh S, Sabate M, Davies J, Lesiak M, Moreno R, Cruz-Gonzalez I, West N, Piek J, Stables R, Van Mieghem NM, Farooq V, Escaned J, Banning A, Onuma Y. 278Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with three-vessel disease: 3-year follow-up of the SYNTAX II study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The clinical implication of state-of-art PCI at long term follow-up in patients with three vessel disease is undetermined.
Purpose
The purpose of the study was to investigate whether the favourable outcomes of state-of-the-art PCI in the SYNTAX-II trial, demonstrated up to 2 years, are maintained at 3-year follow-up.
Methods
The SYNTAX-II study was a multicentre, single arm study that investigated the impact of a state-of-art PCI strategy on clinical outcomes in patients with de novo three vessel coronary artery disease, without left main disease. State-of-art PCI includes: heart team decision-making utilizing the SYNTAX score II, hybrid iFR-FFR decision-making strategy, intravascular ultrasound guided stent implantation, contemporary chronic total occlusion revascularization techniques and guideline-directed medical therapy. The primary endpoint is major adverse cardiac and cerebrovascular events (MACCE – a composite of all-cause death, any stroke, myocardial infarction, or revascularization) at 3 years. Clinical outcomes in SYNTAX-II were compared to the predefined PCI (SYNTAX-I PCI) and coronary artery bypass graft (SYNTAX-I CABG) cohorts from the landmark SYNTAX Trial (SYNTAX-I), selected on the basis of equipoise for long-term (4-year) mortality utilising the SYNTAX Score II.
Results
Between February 2014 and November 2015, 454 patients out of 708 screened patients were enrolled in SYNTAX-II. In SYNTAX-I, 643 (58.8%) patients with 3VD without left main disease had an equipoise recommendation for CABG or PCI based on the SYNTAX Score II and were used as the comparator. At 2 years, MACCE rate in SYNTAX-II was significantly lower compared to SYNTAX-I PCI (13.2% vs. 21.9%, p=0.001). Furthermore, similar two-year outcomes for MACCE were evident between SYNTAX II-PCI and SYNTAX-I CABG (13.2 vs. 15.1%, p=0.42). Three-year results will be presented at ESC2019.
Conclusions
Three-year results of his study may offer an attractive option of revascularization strategy in predefined patients with de novo 3VD (SYNTAX Score II inclusion) even if the patients have moderate to severe anatomical complexity (anatomic SYNTAX score >22).
Acknowledgement/Funding
European Cardiovascular Research Institute (ECRI) with unrestricted research grants from Volcano and Boston Scientific
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Affiliation(s)
- P W J C Serruys
- Imperial College London, Department of Cardiology, London, United Kingdom
| | - S Walsh
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | - M Sabate
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J Davies
- Imperial College London, London, United Kingdom
| | - M Lesiak
- Poznan University of Medical Sciences, Poznan, Poland
| | - R Moreno
- University Hospital La Paz, Madrid, Spain
| | | | - N West
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Stables
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - V Farooq
- Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, United Kingdom
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | - A Banning
- John Radcliffe Hospital, Oxford, United Kingdom
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
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14
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Chichareon P, Modolo R, Tenekecioglu E, Slagboom T, Hofma S, Pijls N, Windecker S, Sabate M, Stoll HP, Onuma Y, Stone G, Serruys PW. P3589New generation stents for primary percutaneous coronary intervention in patients with acute myocardial infarction: evidence from an individual patient data network meta-analysis of randomized clinical. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Drug-eluting stents have shown their superiority in primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). No specific stent type has fully proven its superiority over others.
Purpose
We sought to compare the safety and efficacy of coronary artery stents in STEMI patients undergoing primary PCI through comprehensive network meta-analysis (NMA).
Methods
We performed an individual patient data (IPD) NMA of dedicated randomized trials in STEMI patients treated with coronary stents. The primary endpoint of interest was the composite outcome of cardiac death, any myocardial infarction (MI) or target lesion revascularization (TLR). Secondary outcomes were the individual component of the primary endpoint and definite or probable stent thrombosis. Outcomes were analyzed at the longest available follow-up. The primary analysis was performed using a one-stage random-effects meta-analysis.
Results
IPD from 15 randomized trials in STEMI patients were obtained including a total of 10,979 patients. Six different stent types were studied including bare metal stents (BMS), durable-polymer paclitaxel-eluting stents (DP-PES), durable-polymer sirolimus-eluting stents (DP-SES), durable-polymer zotarolimus-eluting stents (DP-ZES), durable-polymer everolimus-eluting stents (DP-EES) and biodegradable-polymer biolimus-eluting stent (BP-BES).
Mean patient age was 60.7±11.9 years; 22.7% were female and 16.1% were diabetic. Median symptom onset to balloon time was 210 min.
At a median follow-up of 3 years (interquartile range 2–4.9 years), patients treated with second-generation (DP-EES and BP-BES) or first-generation DES (DP-PES, DP-SES and DP-ZES) had significantly lower risk of the primary endpoint than patients treated with BMS (BMS vs. second-generation DES; HR 0.69, 95% CI 0.57–0.82, BMS vs. first-generation DES; HR 0.70, 95% CI 0.61–0.80). The differences were driven by the significant reduction of TLR associated with first- and second-generation DES compared with BMS. A trend towards lower risk of MI with second-generation DES compared with BMS or first-generation DES was observed (BMS vs. second-generation DES; HR 0.79, 95% CI 0.58–1.06, first- vs. second-generation DES; HR 0.75, 95% CI 0.54–1.03). Second-generation DES was associated with a significantly lower risk of definite or probable stent thrombosis compared with BMS (HR 0.62, 95% 0.40–0.97) and first-generation DES (HR 0.55, 95% CI 0.34–0.91). DP-EES and BP-BES had a similar risk of the primary endpoint, individual components of the primary endpoint, and definite or probable stent thrombosis.
Conclusions
In this larger-scale IPD NMA in STEMI patients, second-generation DES were superior to BMS with respect to long-term efficacy and safety outcomes. Second-generation DES were associated with a significant reduction of stent thrombosis compared with BMS and first-generation DES. Similar long-term outcomes were observed between DP-EES and BP-BES.
Acknowledgement/Funding
This study was funded by Biosensors International
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Affiliation(s)
- P Chichareon
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - R Modolo
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | | | - T Slagboom
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - S Hofma
- Medical Center Leeuwarden, Leeuwarden, Netherlands (The)
| | - N Pijls
- Catharina Hospital, Eindhoven, Netherlands (The)
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - H P Stoll
- Biosensors International group, New York, United States of America
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - G Stone
- Columbia University Medical Center, New York, United States of America
| | - P W Serruys
- Imperial College London, London, United Kingdom
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15
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Tomaniak M, Chichareon P, Modolo R, Buszman P, Sabate M, Geisler T, Hamm C, Steg PG, Onuma Y, Vranckx P, Valgimigli M, Windecker S, Anderson R, Dominici M, Serruys PW. P2531Impact of age on clinical outcomes after PCI in patients with ACS and stable CAD treated with 23-month ticagrelor monotherapy following 1-month DAPT in the randomized GLOBAL LEADERS study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0860] [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: 11/15/2022] Open
Abstract
Abstract
Background
The efficacy and safety of ticagrelor monotherapy in elderly patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) or stable coronary artery disease (CAD) has not been evaluated.
Purpose
To evaluate the efficacy and safety of ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI in relation to age and clinical presentation in the GLOBAL LEADERS study cohort.
Methods
This is a subanalysis of the randomized multicentre GLOBAL LEADERS study, comparing the experimental strategy of 23-month ticagrelor monotherapy after 1 month of ticagrelor and aspirin with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy in 15991 patients undergoing PCI. Patients were categorized into elderly and very elderly according to a pre-specified cut-off of 75 years and a post-hoc defined cut-off of 80 years. Impact of age and clinical presentation (ACS versus stable CAD) on clinical outcome at 2 years was evaluated. The primary endpoint was a composite of all-cause mortality or nonfatal, centrally adjudicated, new Q-wave myocardial infarction.
Results
In the overall elderly (>75 years) population (n=2565), primary endpoint occurred in 7.2% of patients in the experimental group and in 9.4% of patients in the reference group (p=0.041) at 2 years (p int =0.23). Elderly patients in the experimental group had a lower rate of definite stent thrombosis (ST) (0.2% vs. 0.9%, p=0.043, p int=0.03), definite or probable ST (0.4 vs. 1.3%, p=0.015, p int=0.01) and a numerically higher rates of BARC 3 or 5 type bleeding (5.0% vs. 3.9%, p=0.192, p int=0.06), when compared to the reference arm.
Among elderly patients presenting with ACS both treatment groups did not differ in the rates of primary endpoint (9.1% vs. 10.8%, p=0.367) and BARC 3 or 5 type bleeding (4.7% vs. 5.7%, p=0.458), whereas among elderly patients with stable CAD the experimental strategy was associated with numerically lower rates of the primary endpoint (5.7% vs. 8.4%, p=0.046) (p int =0.42) and a higher rate of BARC 3 or 5 type bleedings (5.3% vs. 2.6%, p=0.012) (p int =0.02) at 2 years.
Exploratory analyses among very elderly (≥80 years) patients (n=1169) indicated no significant differences between treatment groups in the rates of the primary endpoint (10.2% vs. 11.7% p=0.411, p int=0.940) and BARC 3 or 5 type bleeding (6.0% vs. 5.3%, p=0.630, p int=0.514) at 2 years.
Conclusions
The efficacy and safety of the experimental treatment strategy of 23-month ticagrelor monotherapy after 1-month DAPT following PCI was not identified as age-dependent. Among elderly patients the anti-ischemic benefit was derived at the expense of increased rate of BARC 3 or 5 type bleeding in stable CAD subgroup, but not in ACS subgroup.
Acknowledgement/Funding
European Clinical Research Institute, which received unrestricted grants from Biosensors International, AstraZeneca, and the Medicines Company.
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Affiliation(s)
- M Tomaniak
- Erasmus Medical Centre, ThoraxCenter, Warsaw Medical University, Rotterdam, Netherlands (The)
| | - P Chichareon
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Modolo
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - P Buszman
- Medical University of Silesia, Katowice, Poland
| | - M Sabate
- Clinic Hospital Barcelona, Barcelona, Spain
| | - T Geisler
- Uniklinikum Tübingen, Tübingen, Germany
| | - C Hamm
- University of Giessen, Giessen, Germany
| | - P G Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Paris, France
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - P Vranckx
- Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - M Valgimigli
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - R Anderson
- University Hospital of Wales, Cardiff, United Kingdom
| | - M Dominici
- Azienda Ospedaliera S. Maria, Terni, Italy
| | - P W Serruys
- NHLI, Imperial College London, London, London, United Kingdom
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16
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Jimenez-Quevedo P, Bernardo E, Del Trigo M, Otsuki S, Nombela Franco L, Brugaletta S, Ortega Pozi A, Salinas P, Nunez Gil I, Megia Renteria H, Fernandez Ortiz A, Macaya C, Escaned J, Sabate M, Gonzalo N. P5613Proportional relationship between early mobilization of bone marrow progenitor cells and the extent of vascular injury during coronary stenting: insights on the role of systemic mechanisms of vascular. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0557] [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 role of circulating progenitor cells (CPCs) on vascular repair after everolimus-eluting stent (EES) implantation is largely unknown.
Objectives
The aim of the study was to investigate the quantitative and temporal variations of CPCs levels after EES implantation, and its relationship with the degree of peri-procedural vascular damage, stent healing and neointimal hyperplasia, as measured by optical coherence tomography (OCT).
Methods
In a consecutive series of patients with stable coronary artery disease undergoing stent implantation CPC subpopulations (CD34+/CD45low, CD133+/CD45low, CD34/KDR/CD45low, CD133/KDR/CD45low) were evaluated using a flow cytometry technique at baseline, 1 and 4 weeks. OCT evaluation was performed immediately after stent implantation to quantify stenting-related injury, and at 9-month follow-up to assess mid-term vascular response.
Results
Twenty patients (mean age 66±9 years; 80%male) with 24 stenoses treated with EES were included in the study. Vascular injury score was associated with the increase of CD133+/KDR/CD45 low at 1-week (β0.28 [95% CI0.15; 0.41], p<0.001) and with the maximum neointimal thickness at 9-month follow-up (β0.008 [95% CI-0.0004; 0.002]:p=0.04). Mean neointimal area at 9-month was associated with the increase in the number of CD34+/CD45low at 1 week (β0.029 [95% CI0.025;-0.033]; p<0.0001). Inverse relationships between the number of uncoated and apposed struts at 9-month and the 1-week delta values of CD34/KDR/CD45low and CD133/KDR/CD45low (β-4.49 [95% CI-8.17;-0.82]; p=0.017 and β −12.53 [95% CI: −22.17; −2.90]; p=0.011, respectively) were also found.
Conclusion
Long-term vascular healing after EES implantation is modulated by early changes in levels of CPC subpopulations. This systemic response is proportional to the extent of vessel wall injury. Early mobilization of CPCs influences mid-term strut coverage and the development of neointimal hyperplasia.
Acknowledgement/Funding
Dr Jimenez-Quevedo is a recipient of the ISCIII (Instituto de Salud Carlos III) grant “Fondo de Investigaciόn Sanitaria” (PI11/00299) to perform this
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Affiliation(s)
| | - E Bernardo
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - S Otsuki
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | | | - P Salinas
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | - C Macaya
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Escaned
- Hospital Clinico San Carlos, Madrid, Spain
| | - M Sabate
- Hospital Clinic San Carlos, Madrid, Spain
| | - N Gonzalo
- Hospital Clinico San Carlos, Madrid, Spain
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17
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Loncaric F, Regueiro A, Sanchis L, Sousa M, Doltra A, Prat S, Sabate M, Lamata P, Mortier P, Sitges M. P3695Predicting adverse outcomes after TAVI procedure - a comparison of two CoreValve generations using real-life outcomes and patient-specific computer simulations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
Post-procedure conduction abnormalities (CA) and paravalvular aortic regurgitation (PAR) continue to strain TAVI outcomes. Computer simulations, based on patient-specific anatomy, valve properties, and implantation position, have been validated for prediction of these complications. The new-generation CoreValve Evolut PRO has been shown to have lower levels of PAR and CA than previous generations. The aim was to compare clinical outcomes after Evolut Pro implantation in real-life with outcomes of virtual deployment of the same size, implantation depth adjusted CoreValve Evolut R.
Methods
Patients undergoing Evolut Pro implantation at a single centre were included into the study. Postoperative Doppler echocardiography was assessed to define PAR, the pre- and postoperative 12-lead ECGs for CA, and the postoperative angiograms to measure implantation depth based on annular plane distance from the non-coronary and left coronary aortic valve cusps. Preoperative multislice computed tomography was used to generate patient-specific models of the native aortic root. Implantation of the Evolut R valve and corresponding aortic root deformation was simulated using computational mechanics, whereas blood flow and level of PAR were predicted using computational fluid dynamics. Prediction of CA – new onset left bundle branch block or atrioventricular block type II or III -was based on calculations of contact pressure in a patient-specific region of the aortic root containing the AV conduction system (ROI). Outcomes were predicted in three implantation depth positions - high, medium, low – where the position closest to the real-life implantation depth was chosen for outcome comparisons.
Results
Study diagram is shown in Figure 1. Thirty-three patients (57% female, mean age 82±6 years old) underwent a TAVI intervention with an Evolut PRO valve. Evolut PRO implantation depths were, in general, closest to the lowest modeled Evolut R depth. Comparison demonstrated similar overall incidence of moderate-to-severe PAR. The Evolut R simulation predicted 18 patients without PAR and 2 with PAR. With the Evolute PRO, 1 of the 18 not predicted developed significant PAR, and 1 of the 2 predicted did not develop PAR. CA were notably higher with the Evolut R simulation, where CA were present in 9 out of 12 patients, as compared to the observed 5 out of 12 with the Evolut PRO.
Figure 1
Conclusion
Single-centre outcomes after Evolut Pro implantation in real-life showed a similar overall incidence of moderate-to-severe PAR and a lower incidence of conduction abnormalities as compared to the same size, implantation depth adjusted, patient-specific Evolut R modeled outcomes. As inferred from the results, computer simulations may have high clinical utility in supporting clinical decisions regarding valve choice in TAVI procedures.
Acknowledgement/Funding
Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738)
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Affiliation(s)
- F Loncaric
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Regueiro
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Sanchis
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Doltra
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - S Prat
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - P Lamata
- Kings College London, Department of Biomedical Engineering, London, United Kingdom
| | | | - M Sitges
- Hospital Clinic de Barcelona, Barcelona, Spain
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Mendieta Badimon LG, Ben-Aicha S, Casani L, Gutierrez M, Carreras F, Sabate M, Badimon L, Vilahur G. 2183Intravenous administration of IV-STATIN CARDIOSHIELD during myocardial infarction renders higher cardioprotection than oral atorvastatin given shortly after reperfusion: a translational CMR study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0102] [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
Statins are known to exert rapid cardioprotective effects irrespective of their lipid-lowering properties. Several trials have suggested that high-dose statin treatment may reduce cardiovascular complications in patients undergoing invasive management. However, the ideal timing and administration regime is not clear.
Purpose
We compared the cardioprotective effects derived from IV-STATIN CARDIOSHIELD® administered intravenously during myocardial infarction (MI) with those attained by oral atorvastatin administration shortly after reperfusion. This study was conducted in a preclinical pig model of MI by serial CMR imaging.
Methods
Diet-induced hypercholesterolemic pigs (N=21; cholesterol: 387±74mg/dL) were subjected to 90 minutes of complete coronary occlusion (closed-chest model of MI), then reperfusion was established and animals were kept for 42 days. Within this experimental design animals were distributed in 3 groups (G) (7animals/arm): G1) animals received an intravenous bolus (0.3mg/kg) of IV-STATIN during MI; G2) animals received an intravenous bolus of the vehicle during MI (placebo-control); and G3) animals were administered atorvastatin p.o. initiated within the first 2h post-MI (Atorva-post-MI). G1 and G3 animals remained on atorvastatin p.o. for the following 42 days whereas G2 controls received placebo-pills. We assessed cardiac damage and global and regional functional parameters by CMR at day3 and day42 post-MI. Myocardial samples were processed for molecular studies on cardiac remodeling-related parameters (collagen and AMPK).
Results
CMR analysis at day-3 revealed that G1 pigs showed a marked reduction in infarct size as compared to both G3 and G2 animals (19.1±2.8% LV vs. 29.0±1.8% and 29.3%±3.2%, respectively; p<0.05) with a resultant 50% increase in myocardial salvage (p<0.05 vs. both). At day-42 both G1 and G3 animals showed a significant decrease in the size of the scar vs. G2 animals; however, G1 animals showed a further 24% scar reduction as compared to G3 (14.4±1.1% vs. 18.8±1.0% LV; p<0.05). Functional analyses revealed higher LVESV in G1 animals as compared to G2 (p<0.05) and less wall motion abnormalities in the jeopardized myocardium (p<0.05) vs. both groups at day42 post-MI. Collagen expression and AMPK activation were found to be significantly enhanced in the scar of G1 (p<0.05 vs. both groups). No changes were detected in lipids levels or liver and renal parameters throughout the study in any pig group.
Conclusions
Intravenous IV-STATIN CARDIOSHIELD® treatment during MI limited cardiac damage and improved cardiac function and remodeling to a larger extent than when atorvastatin was administered orally shortly after reperfusion. Our results support this novel regime of intravenous administration of IV-STATIN CARDIOSHIELD® as a routine procedure during MI. Further investigation of the potential benefits of this new therapeutic approach in STEMI patients is warranted.
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Affiliation(s)
| | - S Ben-Aicha
- Cardiovascular Research Program -ICCC, IR-Hospital de Sant Pau, Barcelona, Spain
| | - L Casani
- Cardiovascular Research Program -ICCC, IR-Hospital de Sant Pau, Barcelona, Spain
| | - M Gutierrez
- Cardiovascular Research Program -ICCC, IR-Hospital de Sant Pau, Barcelona, Spain
| | - F Carreras
- Hospital de la Santa Creu i Sant Pau, Cardiology, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - L Badimon
- Cardiovascular Research Program -ICCC, IR-Hospital de Sant Pau, Barcelona, Spain
| | - G Vilahur
- Cardiovascular Research Program -ICCC, IR-Hospital de Sant Pau, Barcelona, Spain
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Cepas Guillen PL, Borrego-Rodriguez J, Flores-Umanzor E, Fernandez-Valledor A, Vazquez S, Echarte Morales JC, Menendez-Suarez P, Iglesias Garriz I, Perez De Prado A, Regueiro A, Brugaletta S, Freixa X, Masotti M, Fernandez-Vazquez F, Sabate M. P1562Outcomes of nonagenarians with ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Developed countries are facing a sustained increase in life expectancy. Elderly people represent the fastest growing portion of cardiovascular patients. However, nonagenarians with ST-segment elevation myocardial infarction (STEMI) are often underrepresented in clinical trials as prolonged follow-up may be compromised by limited life expectancy. The aim of this retrospective study is to analyse the clinical presentation, risk factors, co-morbidities, outcomes of nonagenarian patients presenting with STEMI.
Methods
We included all consecutive nonagenarians presenting with STEMI admitted in 2 academic centers between 2007 and 2017. There were no exclusion criteria. We collected demographic, clinical, and procedural data. All-cause mortality was assessed in-hospital, at 6 months and at 1-year follow-up.
Results
A total of 140 patients (mean age 91.6 years [91.3–92]; 59% females) were included. The number of patients increased over the years (from 6.5 cases per year before 2012 to 14.4 cases per year after 2012). One out of 5 patients presented disability or dependence for activities of daily living (ADL). Emergent catheterization was performed in 70% of our patients, and primary percutaneous coronary intervention (pPCI) in 57% (n=80). The use of bare metal stent was preponderant (72%) in this cohort. Successful revascularization of the culprit vessel was achieved in 90% of patients. Dual antiplatelet therapy with aspirin and clopidogrel was used in 97% of patients. Overall, in-hospital mortality was 22%, increased up to 27% at 6 months and up to 34% at 1-year follow-up. In-hospital mortality was lower in pPCI group than in conservative group (13.7% versus 31.6%, adjusted OR: 0.17, 95% CI: 0.04–0.67, P<0.01). One-year mortality was also lower in pPCI group than in conservative group (26% versus 45%, P<0.01). Multivariable analysis identified mechanical complications (adjusted OR: 28.1, 95% CI: 3.18–247.7, P<0.01), Killip class (III/IV) (adjusted OR: 4.19, 95% CI: 3.37–22.3, P<0.01) and pPCI (adjusted OR: 0.40, 95% CI: 0. 16- 0. 95, P<0.05) as independent predictors of all-cause mortality at 1 year.
Conclusions
STEMI in nonagenarians is becoming more and more common. pPCI may be also the preferred strategy in this high-risk cohort. The hemodynamic compromise (Killip class III/IV), the presence of complications related to myocardial infarction and early revascularization may be related to prognosis of these patients.
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Affiliation(s)
| | | | | | | | - S Vazquez
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | | | | | | | | | - A Regueiro
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - S Brugaletta
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - X Freixa
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - M Masotti
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | | | - M Sabate
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
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Bobi J, Ortiz-Lopez L, Danti N, Ortega-Paz L, Pujol-Lopez M, Costa F, Lazaro I, Sabate M, Brugaletta S, Dantas AP. 5988Circulating exosomes from patients with coronary syndrome inhibit angiogenesis and trigger inflammatory pathways in vitro through TLR activation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Bobi
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - L Ortiz-Lopez
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - N Danti
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - L Ortega-Paz
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - M Pujol-Lopez
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - F Costa
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - I Lazaro
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - M Sabate
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - S Brugaletta
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - A P Dantas
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Department of Cardiology, Hospital Clínic, Barcelona, Spain
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21
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Asano T, Onuma Y, Collet C, Sabate M, Morice M, Chevalier B, Windecker S, Serruys P. P573Angiographic late lumen loss revisited: impact on target lesion revascularization and device thrombosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Asano
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - Y Onuma
- Erasmus Medical Center, Rotterdam, Netherlands
| | - C Collet
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Morice
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - B Chevalier
- Institut Cardiovasculaire Paris Sud, Paris, France
| | | | - P Serruys
- Imperial College London, London, United Kingdom
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22
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Cepas Guillen PL, Flores Umanzor E, Martin Yuste V, Fernandez Valledor A, Vazquez S, Pujol Lopez M, San Antonio R, Caldentey G, Ivey Miranda J, Jimenez Britez G, Regueiro A, Freixa X, Ferreira I, Sabate M. P3476Long-term survival benefit of CTO revascularisation vs. conservative treatment in elderly patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - V Martin Yuste
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | | | - S Vazquez
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - M Pujol Lopez
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - R San Antonio
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - G Caldentey
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - J Ivey Miranda
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | | | - A Regueiro
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - X Freixa
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
| | - I Ferreira
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain
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23
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Garcia-Lunar I, Pereda D, Santiago E, Solanes N, Nuche Berenguer J, Ascaso M, Bobi Q, Sierra F, Galan C, Sanchez-Quintana D, Rigol M, Fuster V, Sabate M, Ibanez B, Garcia-Alvarez A. P245Effect of pulmonary artery denervation in a translational model of chronic postcapillary pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Garcia-Lunar
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
| | - D Pereda
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Santiago
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - N Solanes
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J Nuche Berenguer
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
| | - M Ascaso
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Q Bobi
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - F Sierra
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
| | - C Galan
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
| | - D Sanchez-Quintana
- Universidad de Extremadura, Departamento de Anatomía y Biología Celular, Facultad de Medicina, Badajoz, Spain
| | - M Rigol
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - V Fuster
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - B Ibanez
- Centro Nacional de Investigaciones Cardiovasculares, CNIC Carlos III, Madrid, Spain
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24
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Robles C, Martin Yuste V, Brugaletta S, Freixa X, Regueiro A, Castell A, Perez Villa F, Sabate M. P5523Left vs right radial access: a randomized comparative study of routine catheterization in heart transplanted patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5523] [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: 11/12/2022] Open
Affiliation(s)
- C Robles
- University Hospital of Virgen Macarena, Endovascular Service., Seville, Spain
| | - V Martin Yuste
- Hospital Clinic de Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
| | - S Brugaletta
- Hospital Clinic de Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
| | - X Freixa
- Hospital Clinic de Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
| | - A Regueiro
- Hospital Clinic de Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
| | - A Castell
- Hospital Clinic de Barcelona, Heart Failure and Transplant, Barcelona, Spain
| | - F Perez Villa
- Hospital Clinic de Barcelona, Heart Failure and Transplant, Barcelona, Spain
| | - M Sabate
- Hospital Clinic de Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
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25
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Moscarella E, Spitaleri G, Brugaletta S, Pernigotti A, Ortega Paz L, Cequier A, Iniguez A, Serra A, Jimenez-Quevedo P, Mainar V, Campo G, Tespili M, Valgimigli M, Serruys P, Sabate M. P5604Impact of body mass index on outcomes after everolimus-eluting stents versus bare metal stents implantation in patients with ST-segment elevation myocardial infarction: insights the EXAMINATION trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5604] [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: 11/12/2022] Open
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26
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Cubedo J, Suades R, Padro T, Martin-Yuste V, Sabate M, Cinca J, Sans-Rosello J, Sionis A, Badimon L. P2126Heme proteins and STEMI: implications in prognosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2126] [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: 11/13/2022] Open
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27
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Garcia Blas S, Ortega-Paz L, Valero E, Brugaletta S, Minana G, Dantas A, Garabito M, Nunez J, Carratala A, Sabate M, Sanchis J. P473Intracoronary cell-free DNA is associated with microvascular damage in ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p473] [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: 11/13/2022] Open
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28
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Bobi J, Solanes N, Ishida K, Dantas A, Regueiro A, Castillo N, Sabate M, Rigol M, Freixa X. 1948Deep hypothermia slows coronary blood velocity and increases endothelium-dependent vasodilator response in a porcine model. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1948] [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: 11/14/2022] Open
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29
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Scalone G, Brugaletta S, Gomez O, Otsuki S, Sabate M. Bioresorbable scaffolds: focus on vascular response and long-term safety. Panminerva Med 2015; 57:1-13. [PMID: 25373397] [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: 06/04/2023]
Abstract
Bioresorbable vascular scaffolds (BVS) are considered the fourth revolution in Interventional Cardiology, thus promising to address some of the pending issues with current-generation drug eluting stents (DES). Notably, most of the potential advantages of BVS over other current devices are due to a peculiar vascular response, called "vascular restoration therapy". The emerging data from real-world expanded use registries suggest that BVS use is feasible in a wide variety of patients (from low- to high- risk), and lesions (from simplex to complex). However, few safety concerns with currently available BVS have arised from initial experiences all over the word. Data from ongoing large-scale randomized controlled trials will be able to demonstrate whether BVS improve patient early and long-term outcomes compared to best-in-class DES.
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Affiliation(s)
- G Scalone
- Thorax Institute. Department of Cardiology IDIBAPS: Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS) Hospital Clinic, Barcelona, Spain -
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30
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Romaguera R, Brugaletta S, Gomez-Lara J, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro J, Teruel L, Gómez-Hospital J, Montanya E, Alfonso F, Valgimigli M, Sabate M, Cequier A. Rationale and study design of the RESERVOIR trial: A randomized trial comparing reservoir-based polymer-free amphilimus-eluting stents versus everolimus-eluting stents with durable polymer in patients with diabetes mellitus. Catheter Cardiovasc Interv 2014; 85:E116-22. [DOI: 10.1002/ccd.25728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 06/05/2014] [Accepted: 11/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- R. Romaguera
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - S. Brugaletta
- Department of Cardiology, Thorax Institute; Hospital Clinic, University of Barcelona; Barcelona Spain
| | - J. Gomez-Lara
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - E. Pinar
- Department of Cardiology; Hospital Virgen de la Arrixaca; Murcia Spain
| | - P. Jiménez-Quevedo
- Department of Cardiology, Cardiovascular Institute; Hospital Clínico San Carlos; Madrid Spain
| | - M. Gracida
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - G. Roura
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - J.L. Ferreiro
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - L. Teruel
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - J.A. Gómez-Hospital
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
| | - E. Montanya
- Endocrine Unit, Hospital de Bellvitge; IDIBELL, CIBERDEM, University of Barcelona; Barcelona Spain
| | - F. Alfonso
- Department of Cardiology; Hospital la Princesa; Madrid Spain
| | - M. Valgimigli
- Department of Cardiology, Erasmus MC; Thoraxcenter; Rotterdam the Netherlands
| | - M. Sabate
- Department of Cardiology, Thorax Institute; Hospital Clinic, University of Barcelona; Barcelona Spain
| | - A. Cequier
- Department of Cardiology, Heart Diseases Institute, Hospital de Bellvitge; IDIBELL, University of Barcelona; Barcelona Spain
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31
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Kristensen SD, Laut KG, Fajadet J, Kaifoszova Z, Kala P, Di Mario C, Wijns W, Clemmensen P, Agladze V, Antoniades L, Alhabib KF, De Boer MJ, Claeys MJ, Deleanu D, Dudek D, Erglis A, Gilard M, Goktekin O, Guagliumi G, Gudnason T, Hansen KW, Huber K, James S, Janota T, Jennings S, Kajander O, Kanakakis J, Karamfiloff KK, Kedev S, Kornowski R, Ludman PF, Merkely B, Milicic D, Najafov R, Nicolini FA, No c M, Ostojic M, Pereira H, Radovanovic D, Sabate M, Sobhy M, Sokolov M, Studencan M, Terzic I, Wahler S, Widimsky P. Corrigendum to: Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014. [DOI: 10.1093/eurheartj/ehu333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Rafael Ferreira J, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabate M, Senior R, Taggart DP, van der Wall EE, Vrints CJM. Corrigendum to: '2013 ESC guidelines on the management of stable coronary artery disease'. Eur Heart J 2014. [DOI: 10.1093/eurheartj/ehu038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Shiratori Y, Brugaletta S, Cola C, Martin-Yuste V, Garcia Del Blanco B, Ruiz-Salmeron R, Diaz J, Pinar E, Masotti M, Sabate M. Vascular response at proximal and distal edges between polymer-free and polymer-based paclitaxel-eluting stents: intravascular ultrasound analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3945] [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: 11/14/2022] Open
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Ruiz Garcia J, Moreno R, Teles R, Rumoroso JR, Carvalho HC, Garcia E, Sabate M, Goicolea J, Mainar V, Mauri J. Comparison between diabetics and non-diabetic patients after successful percutaneous coronary intervention for chronic total occlusion in the DES era: Data from the CIBELES trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2145] [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: 11/13/2022] Open
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Guerrero C, Mendoza E, Berthoumieux E, Cano-Ott D, González-Romero E, Sabate M. Neutron capture and fission reactions on235U: cross sections,α-ratios and promptγ-ray emission from fission. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20134201002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hernandez-Vela A, Gatta C, Escalera S, Igual L, Martin-Yuste V, Sabate M, Radeva P. Accurate Coronary Centerline Extraction, Caliber Estimation, and Catheter Detection in Angiographies. ACTA ACUST UNITED AC 2012; 16:1332-40. [DOI: 10.1109/titb.2012.2220781] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sabate M, García J, Valls E, Moragas M, Soler M, Riera E, Lomeña F. Utility of the PET-CT Scan with 18F-FDG in a Case of Choroid Melanoma Recurrence. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sabate M, García JR, Valls E, Moragas M, Soler M, Riera E, Lomeña F. Utility of the PET-CT scan with (18)F-FDG in a case of choroid melanoma recurrence. Rev Esp Med Nucl Imagen Mol 2011; 31:167-8. [PMID: 22177294 DOI: 10.1016/j.remn.2011.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022]
Affiliation(s)
- M Sabate
- CETIR-ERESA Unidad PET/TC Esplugues, Barcelona, Spain
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Fraser AG, Daubert JC, Van de Werf F, Estes NAM, Smith SC, Krucoff MW, Vardas PE, Komajda M, Anker S, Auricchio A, Bailey S, Bonhoeffer P, Borggrefe M, Brodin LA, Bruining N, Buser P, Butchart E, Calle Gordo J, Cleland J, Danchin N, Daubert J, Degertekin M, Demade I, Denjoy N, Derumeaux G, Di Mario C, Dickstein K, Dudek D, Estes N, Farb A, Flotats A, Fraser A, Gueret P, Israel C, James S, Kautzner J, Komajda M, Krucoff M, Lombardi M, Marwick T, Mioulet M, O'Kelly S, Perrone-Filardi P, Rosano G, Rosenhek R, Sabate M, Smith S, Swahn E, Tavazzi L, Van de Werf F, van der Velde E, van Herwerden L, Vardas P, Voigt JU, Weaver D, Wilmshurst P. Clinical evaluation of cardiovascular devices: principles, problems, and proposals for European regulatory reform: Report of a policy conference of the European Society of Cardiology. Eur Heart J 2011; 32:1673-86. [DOI: 10.1093/eurheartj/ehr171] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Affiliation(s)
- C Di Mario
- Royal Brompton Hospital, London SW3 6NP, UK.
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Prieto C, Vano E, Fernández JM, Galvan C, Sabate M, Gonzalez L, Martinez D. Six years experience in intracoronary brachytherapy procedures: patient doses from fluoroscopy. Br J Radiol 2006; 79:730-3. [PMID: 16793849 DOI: 10.1259/bjr/75766147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/05/2022] Open
Abstract
Typical patient dose levels during intracoronary brachytherapy (ICB) procedures using beta sources were determined across a sample of 221 treatments. Dose-area product values, fluoroscopy time and number of frames per procedure, with median values of 62 Gy cm2, 17.0 min and 1493 images, respectively, resulted in a 20% to 50% increase in the values measured for percutaneous transluminal coronary angioplasty procedures in the same medical centre (median values 41 Gy cm2, 14.3 min and 1078 images). Likely reasons for this increase include the additional complexity of ICB, the need for recording and reporting every step of the treatment, getting the essential parameters for the volume determination of the lesion and therapeutic radiation dose calculation and, finally, the learning curve for this kind of procedure. A high concentration skin dose distribution during ICB procedures was measured and in 12% of the patients peak skin doses higher than 1.5 Gy were confirmed. 10 patients were submitted to clinical follow-up and skin injuries were not identified.
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Affiliation(s)
- C Prieto
- Medical Physics Service, San Carlos University Hospital, 28040 Madrid, Spain
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Waksman R, Torguson R, Sabate M, Chu W, Pichard A, Satler L, Suddath W, Kent K. Intravascular radiation therapy versus drug-eluting stenting for the treatment of patients with drug-eluting stent restenosis. Cardiovascular Revascularization Medicine 2006. [DOI: 10.1016/j.carrev.2006.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vano E, Prieto C, Fernandez JM, Gonzalez L, Sabate M, Galvan C. Skin dose and dose-area product values in patients undergoing intracoronary brachytherapy. Br J Radiol 2003; 76:32-8. [PMID: 12595323 DOI: 10.1259/bjr/33961719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Entrance skin doses, dose-area product (DAP) values, fluoroscopy times and digital cine acquisition data were measured for 86 patients undergoing intracoronary brachytherapy procedures with beta sources, to estimate risk of skin injuries. Interventions were carried out in three dedicated X-ray interventional cardiology rooms equipped with X-ray systems operating in pulsed modes, with high filtration and edge filter options. Skin dose distribution was analysed in detail in 56 patients using slow films and thermoluminescent dosimetry. Digital recording of Digital Imaging and Communications in Medicine cine images also allowed analysis of the technical parameters used throughout the procedures. A protocol for clinical follow-up of these patients at the cardiology service is also presented, which prescribes special attention when a threshold dose is reached. Median values for DAP, fluoroscopy time and number of frames were 81.2 Gy cm(2), 17.5 min and 1569 frames, respectively, and maximum values were 323.3 Gy cm(2), 46.2 min and 3213 frames, respectively. In two cases, maximum skin doses in a procedure reached 3.5 Gy and 4.6 Gy. Comparing median values in this study, intracoronary brachytherapy involved approximately two-fold the DAP used in percutaneous transluminal coronary angioplasty procedures performed during the same period in the same catheterization laboratories, as a consequence of the need to monitor the radioactive source location used for the treatment of stenoses and the intravascular ultrasound. Special care must be paid in those cases of high dose in relation to potential patient skin injuries and late effects.
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Affiliation(s)
- E Vano
- Interventional Cardiology Service, San Carlos University Hospital, 28040 Madrid, Spain
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Escaned J, Segovia J, Flores A, Aragoncillo P, Salas C, Alfonso F, López M, Garcia-Touchard A, Fernandez-Ortiz A, Hernandez R, Bañuelos C, Sabate M, Alonso-Pulpon L, Macaya C. Assessment of coronary microcirculation in cardiac allografts. a comparison of intracoronary physiology, intravascular ultrasound and histological morphometry. J Heart Lung Transplant 2001; 20:204-205. [PMID: 11250366 DOI: 10.1016/s1053-2498(00)00439-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- J Escaned
- 1Hospital Clinico San Carlos, Madrid, Spain; 2Hospital Puerta de Hierro, Madrid, Spain
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Segovia J, Alonso-Pulpon L, Escaned J, Alfonso F, Flores A, Fernandez-Ortiz A, Hernandez-Antolin R, Bañuelos C, Sabate M, Macaya C. Prognostic value of a new intravascular ultrasound score in graft vessel disease. J Heart Lung Transplant 2001; 20:151. [PMID: 11250211 DOI: 10.1016/s1053-2498(00)00258-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- J Segovia
- Clinica Puerta de Hierro, Madrid, Madrid, Spain
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Kay IP, Sabate M, Van Langenhove G, Heyndrickx GR, Grollier G, Suyrapranata H, Hoorntje JC, van der Giessen WJ, Morel MA, Disco C, Serruys PW. The ESSEX (European Scimed Stent Experience) study. Catheter Cardiovasc Interv 2000; 50:419-25. [PMID: 10931613 DOI: 10.1002/1522-726x(200008)50:4<419::aid-ccd11>3.0.co;2-o] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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] [Indexed: 11/09/2022]
Abstract
The aim of the study was to assess the safety and feasibility of implantation of the Scimed Radius stent. Secondary objectives were to assess the result of stent placement by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The ESSEX study was a prospective, multicenter, observational study in which candidates for a single elective stent implantation, in a de novo or restenotic lesion, reference diameter 2.75-4.00 mm and target lesion < 14 mm in length, were enrolled. QCA at baseline, postprocedure, and 6-month follow-up was performed. IVUS was used to assess optimal stent implantation. One hundred and three patients were enrolled. Forty-four percent of the patients had unstable angina. Stent implantation was technically successful in all patients. Additional stents were implanted in 17 patients for procedural dissection (16) and spasm (1). Ninety-seven percent of patients were event-free at 1 month and 76% at 6-month follow-up. Angiographic restenosis rates for de novo lesions and for all patients were 19% and 21%, respectively. Clinical events occurred at 1- and 6-month follow-up in 2.9% and 24.3% of patients, respectively. No patients suffered subacute thrombosis. Retrospective analysis of peak balloon inflation pressure (< or = 12 and > 12 atm) as a determinant of clinical, QCA, and IVUS outcomes suggested no benefit or detrimental effect from optimization with high-pressure balloon inflation. Implantation of the self-expanding Radius stent is safe and efficacious. Based on registry data, clinical, angiographic, and IVUS, data comparable with modern balloon-expandable stents were obtained.
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Affiliation(s)
- I P Kay
- Thoraxcenter, Rotterdam, The Netherlands
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Alfonso F, Flores A, Escaned J, Sanmartín M, Hernández R, Fernández-Ortíz A, Bañuelos C, Sabate M, Macaya C. Pressure wire kinking, entanglement, and entrapment during intravascular ultrasound studies: a potentially dangerous complication. Catheter Cardiovasc Interv 2000; 50:221-5. [PMID: 10842396 DOI: 10.1002/(sici)1522-726x(200006)50:2<221::aid-ccd18>3.0.co;2-i] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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] [Indexed: 11/10/2022]
Abstract
The simultaneous use of intravascular ultrasound catheters and sensor-tipped guidewires is gaining acceptance during coronary interventions as a means to gain further insights on the significance of coronary stenoses. Herein we describe four patients in whom the distal tip of the pressure wire became entrapped during an intravascular ultrasound examination. In the four patients, a localized kinking of the pressure wire initially prevented the removal of the imaging catheter and eventually the wire-catheter assembly had to be retrieved as a unit into the guiding catheter. In one patient, unraveling of the distal part of the pressure wire was noticed. In two patients, a complete loop with further kinking of the pressure wire was induced during the maneuvers performed to withdraw the imaging system. Three patients experienced transient angina. Although in our patients this technical problem was not associated with any clinical sequelae, interventional cardiologists should be aware of the potential complications associated with the combined use of these two intracoronary diagnostic tools.
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Affiliation(s)
- F Alfonso
- Interventional Cardiology Unit, Hospital Universitario "San Carlos," Madrid, Spain
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48
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Burette R, Benit E, Bonan R, Goy J, Jenkins S, King S, Sabate M, Safian R, Serruys P, Snell J, Urban P, Werner J. 89 Compassionate use of coronary beta-radiation. Radiother Oncol 2000. [DOI: 10.1016/s0167-8140(00)81410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Kay IP, Sabate M, Van Langenhove G, Costa MA, Wardeh AJ, Gijzel AL, Deshpande NV, Carlier SG, Coen VL, Levendag PC, Van der Giessen W, de Feyter PJ, Serruys PW. Outcome from balloon induced coronary artery dissection after intracoronary beta radiation. Heart 2000; 83:332-7. [PMID: 10677416 PMCID: PMC1729352 DOI: 10.1136/heart.83.3.332] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the healing of balloon induced coronary artery dissection in individuals who have received beta radiation treatment and to propose a new intravascular ultrasound (IVUS) dissection score to facilitate the comparison of dissection through time. DESIGN Retrospective study. SETTING Tertiary referral centre. PATIENTS 31 patients with stable angina pectoris, enrolled in the beta energy restenosis trial (BERT-1.5), were included. After excluding those who underwent stent implantation, the evaluable population was 22 patients. INTERVENTIONS Balloon angioplasty and intracoronary radiation followed by quantitative coronary angiography (QCA) and IVUS. Repeat QCA and IVUS were performed at six month follow up. MAIN OUTCOME MEASURES QCA and IVUS evidence of healing of dissection. Dissection classification for angiography was by the National Heart Lung Blood Institute scale. IVUS proven dissection was defined as partial or complete. The following IVUS defined characteristics of dissection were described in the affected coronary segments: length, depth, arc circumference, presence of flap, and dissection score. Dissection was defined as healed when all features of dissection had resolved. The calculated dose of radiation received by the dissected area in those with healed versus non-healed dissection was also compared. RESULTS Angiography (type A = 5, B = 7, C = 4) and IVUS proven (partial = 12, complete = 4) dissections were seen in 16 patients following intervention. At six month follow up, six and eight unhealed dissections were seen by angiography (A = 2, B = 4) and IVUS (partial = 7, complete = 1), respectively. The mean IVUS dissection score was 5.2 (range 3-8) following the procedure, and 4.6 (range 3-7) at follow up. No correlation was found between the dose prescribed in the treated area and the presence of unhealed dissection. No change in anginal status was seen despite the presence of unhealed dissection. CONCLUSION beta radiation appears to alter the normal healing process, resulting in unhealed dissection in certain individuals. In view of the delayed and abnormal healing observed, long term follow up is indicated given the possible late adverse effects of radiation. Although in this cohort no increase in cardiac events following coronary dissections was seen, larger populations are needed to confirm this phenomenon. Stenting of all coronary dissections may be warranted in patients scheduled for brachytherapy after balloon angioplasty.
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Affiliation(s)
- I P Kay
- Thoraxcenter Bd 418, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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50
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Costa MA, Sabate M, Serrano P, van der Giessen WJ, Kozuma K, Kay IP, Coen VL, Ligthart JM, Wardeh A, Levendag PC, Serruys PW. The effect of 32P beta-radiotherapy on both vessel remodeling and neointimal hyperplasia after coronary balloon angioplasty and stenting: a three-dimensional intravascular ultrasound investigation. J Invasive Cardiol 2000; 12:113-20. [PMID: 10731276] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Intracoronary radiation is a promising therapy to decrease restenosis after percutaneous intervention. The aim of this pilot study was to determine the mechanism of intracoronary beta-radiation after balloon angioplasty and stenting in a double-blind placebo-controlled randomized fashion. Twenty-six patients were randomized to either placebo (n = 6) or 3 doses (28, 35 and 42 Gy) of beta-radiation (n = 20) using the Guidant brachytherapy system (27 mm long 32P source wire). Of these, 21 patients underwent post-procedure and 6-month follow-up three-dimensional intravascular ultrasound (IVUS) assessment. Volumetric quantification was performed by means of a semi-automated contour detection system after an ECG-gated motorized pullback IVUS imaging and three-dimensional reconstruction. We compared the volumetric changes (Delta) of total vessel volume (TVV), plaque volume (PV) and lumen volume (LV) after 6 months between placebo (dummy wire) and irradiated patients. In addition, the volume of neointimal hyperplasia was quantified within the stented segments. There was an opposite behavior of TVV and LV change between placebo (DeltaTVV = -24 mm3 and DeltaLV = -42 mm3) and irradiated (DeltaTVV = +18 mm3 and (DeltaLV = +5 mm3) patients. The mean neointimal formation within the stented segment in the irradiated patients (n = 7) was 1.9 mm3 (1.5%). Our results suggest that beta-radiation affects vessel remodeling after percutaneous intervention and inhibit neointimal formation in stented patients.
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Affiliation(s)
- M A Costa
- Interventional Cardiology, University Hospital Dijkzigt, Thoraxcenter Bd418, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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