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Elbasha K, Kaur J, Abdelghani M, Landt M, Alotaibi S, Abdelaziz A, Abdel-Wahab M, Toelg R, Geist V, Richardt G, Allali A. Ten-year Durability, Hemodynamic Performance, and Clinical Outcomes after Transcatheter Aortic Valve Implantation Using a Self-expanding Device. Cardiol Ther 2024:10.1007/s40119-024-00369-2. [PMID: 38734999 DOI: 10.1007/s40119-024-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system. METHODS An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015. Bioprosthetic valve failure (BVF) was defined as any bioprosthetic valve dysfunction-related death, re-intervention, or severe hemodynamic valve deterioration. RESULTS At the time of TAVI, the mean age was 80.41 ± 7.01 years, and the Society of Thoracic Surgeons (STS) score was 6.13 ± 5.23%. At latest follow-up (median [IQR]: 5 [2-7] years), cumulative all-cause mortality rates at 3, 5, 7, and 10 years was 23.7%, 40%, 65.8%, and 89.8%, respectively. Mean aortic valve area and transvalvular gradient post-TAVI and at 5, 7, and 10 years were 1.94, 1.87, 1.69, and 1.98 cm2 (p = 0.236) and 8.3, 9.0, 8.2, and 10.1 mmHg (p = 0.796), respectively. Overall, 11 patients had BVF, of whom six had structural valve deterioration (SVD). The 10-year actual and actuarial freedom from BVF was 96.1% and 78.8%, and from SVD was 97.9% and 80.9%, respectively. Three patients developed significant non-SVD due to severe paravalvular leakage, and two patients were diagnosed with infective endocarditis. CONCLUSION Using an early-generation self-expanding bioprosthesis, we documented durable hemodynamic performance and low rates of BVF and SVD up to 10 years after TAVI.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Jatinderjit Kaur
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Cardiology Unit, Department of Internal Medicine, Sohar Hospital, Sohar, Oman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martin Landt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Sultan Alotaibi
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig at the University of Leipzig, Leipzig, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- University Heart Centre Lübeck, Medical Clinic II, Lübeck, Germany
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Garcia-Garcia HM, Waksman R, Melaku GD, Garg M, Beyene S, Wlodarczak A, Kerai A, Levine MB, van der Schaaf RJ, Torzewski J, Ferdinande B, Escaned J, Iglesias JF, Bennett J, Toth GG, Joner M, Toelg R, Wiemer M, Olivecrona G, Vermeersch P, Haude M. Temporal changes in coronary plaque as assessed by an artificial intelligence-based optical coherence tomography: from the first-in-human trial on DREAMS 3G scaffold. Eur Heart J Cardiovasc Imaging 2024; 25:491-497. [PMID: 37936296 DOI: 10.1093/ehjci/jead299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up. METHODS AND RESULTS A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography (OCT) pre- and post-DREAMS 3G implantation and at 6 and 12 M. OCTPlus software uses artificial intelligence to assess composition (i.e. lipid, calcium, and fibrous tissue) of the plaque. The differences between the OCT-derived minimum lumen area (MLA) post-percutaneous coronary intervention and 12 M were grouped into three terciles. Patients with larger MLA differences at 12 M (P = 0.0003) had significantly larger content of fibrous tissue at baseline. There was a reduction of 24.8% and 20.9% in lipid area, both P < 0.001, between the pre-DREAMS 3G OCT and the 6 and 12 M follow-up. Conversely, the fibrous tissue increased by 48.4% and 36.0% at 6 and 12 M follow-up, both P < 0.001. CONCLUSION The larger the fibrous tissue in the lesion at baseline, the larger the luminal loss seen at 6 and 12 M. Following the implantation of DREAMS 3G, favourable healing of the vessel coronary wall occurs as shown by a decrease in the lipid area and an increase in fibrous tissue.
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Affiliation(s)
- Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Gebremedhin D Melaku
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Mohil Garg
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Solomon Beyene
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Adrian Wlodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia SA, Lubin, Poland
| | - Ajay Kerai
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | - Molly B Levine
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA
| | | | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost Limburg (ZOL), Genk, Belgium
| | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Juan F Iglesias
- Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gabor G Toth
- Division Cardiology, Medical University Graz, Graz, Austria
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Göran Olivecrona
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Paul Vermeersch
- Interventional Cardiology, ZNA Middelheim, Antwerpen, Belgium
| | - Michael Haude
- Medical Clinic I, Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
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Borlich M, Zeymer U, Wienbergen H, Hobbach HP, Cuneo A, Bekeredjian R, Ritter O, Hailer B, Hertting K, Hennersdorf M, Scholtz W, Lanzer P, Mudra H, Schwefer M, Schwimmbeck PL, Liebetrau C, Thiele H, Claas C, Riemer T, Zahn R, Iden L, Richardt G, Toelg R. Impact of Access Site on Periprocedural Bleeding and Cerebral and Coronary Events in High-Bleeding-Risk Percutaneous Coronary Intervention: Findings from the RIVA-PCI Trial. Cardiol Ther 2024; 13:89-101. [PMID: 38055177 PMCID: PMC10899132 DOI: 10.1007/s40119-023-00343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION The preference for using transradial access (TRA) over transfemoral access (TFA) in patients requiring percutaneous coronary intervention (PCI) is based on evidence suggesting that TRA is associated with less bleeding and fewer vascular complications, shorter hospital stays, improved quality of life, and a potential beneficial effect on mortality. We have limited study data comparing the two access routes in a patient population with atrial fibrillation (AF) undergoing PCI, who have a particular increased risk of bleeding, while AF itself is associated with an increased risk of thromboembolism. METHODS Using data from the RIVA-PCI registry, which includes patients with AF undergoing PCI, we analyzed a high-bleeding-risk (HBR) cohort. These patients were predominantly on oral anticoagulants (OAC) for AF, and the PCI was performed via radial or femoral access. Endpoints examined were in-hospital bleeding (BARC 2-5), cerebral events (TIA, hemorrhagic or ischemic stroke) and coronary events (stent thrombosis and myocardial infarction). RESULTS Out of 1636 patients, 854 (52.2%) underwent TFA, while 782 (47.8%) underwent the procedure via TRA, including nine patients with brachial artery puncture. The mean age was 75.5 years. Groups were similar in terms of age, sex distribution, AF type, cardiovascular history, risk factors, and comorbidities, except for a higher incidence of previous bypass surgeries, heart failure, hyperlipidemia, and chronic kidney disease (CKD) with a glomerular filtration rate (GFR) < 60 ml/min in the TFA group. No clinically relevant differences in antithrombotic therapy and combinations were present at the time of PCI. However, upon discharge, transradial PCI patients had a higher rate of triple therapy, while dual therapy was preferred after transfemoral procedures. Radial access was more frequently chosen for non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) cases (NSTEMI 26.6% vs. 17.0%, p < 0.0001; UAP 21.5% vs. 14.5%, p < 0.001), while femoral access was more common for elective PCI (60.3% vs. 44.1%, p < 0.0001). No differences were observed for ST-segment elevation myocardial infarction (STEMI). Both groups had similar rates of cerebral events (TFA 0.2% vs. TRA 0.3%, p = 0.93), but the TFA group had a higher incidence of bleeding (BARC 2-5) (4.2% vs. 1.5%, p < 0.01), mainly driven by BARC 3 bleeding (1.5% vs. 0.4%, p < 0.05). No significant differences were found for stent thrombosis and myocardial infarction (TFA 0.2% vs. TRA 0.3%, p = 0.93; TFA 0.4% vs. TRA 0.1%, p = 0.36). CONCLUSIONS In HBR patients with AF undergoing PCI for acute or chronic coronary syndrome, the use of TRA might be associated with a decrease in in-hospital bleeding, while not increasing the risk of embolic or ischemic events compared to femoral access. Further studies are required to confirm these preliminary findings.
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Affiliation(s)
- Martin Borlich
- Herz- und Gefäßzentrum, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Bad Segeberg, Germany.
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | | | | | | | | | - Birgit Hailer
- Katholische Kliniken Essen-Nord-West gGmbH, Essen, Germany
| | | | | | | | - Peter Lanzer
- Gesundheitszentrum Bitterfeld Wolfen, Bitterfeld, Germany
| | - Harald Mudra
- Städtisches Krankenhaus Neuperlach-München, Munich, Germany
| | | | | | | | - Holger Thiele
- Herzzentrum Leipzig der Universität Leipzig, Leipzig, Germany
| | - Christoph Claas
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Riemer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Leon Iden
- Herz- und Gefäßzentrum, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Herz- und Gefäßzentrum, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Bad Segeberg, Germany
| | - Ralph Toelg
- Herz- und Gefäßzentrum, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Bad Segeberg, Germany
- Medizinische Fakultät der Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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Sardella G, Spirito A, Sartori S, Angiolillo DJ, Vranckx P, Hernandez JMDLT, Krucoff MW, Bangalore S, Bhatt DL, Campo G, Cao D, Chehab BM, Choi JW, Feng Y, Ge J, Godfrey K, Hermiller J, Kunadian V, Makkar RR, Maksoud A, Neumann FJ, Picon H, Saito S, Thiele H, Toelg R, Varenne O, Vogel B, Zhou Y, Valgimigli M, Windecker S, Mehran R. 1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT Global Program. Am J Cardiol 2024; 214:94-104. [PMID: 38185438 DOI: 10.1016/j.amjcard.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 12/24/2023] [Indexed: 01/09/2024]
Abstract
This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from 3 prospective, single-arm studies (XIENCE Short DAPT Program), including patients with high bleeding risk successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary end point was all-cause death or myocardial infarction (MI). The key secondary end point was Bleeding Academic Research Consortium type 2 to 5 bleeding. The outcomes were assessed from 1 to 12 months after index PCI. Of 3,364 patients, 2,241 (66.6%) were aged ≥75 years. The risk of death or MI was similar with 1- versus 3-month DAPT in patients aged ≥75 (8.5% vs 8.0%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.69 to 1.30) and <75 years (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60 to 1.57, interaction p = 0.478). Bleeding Academic Research Consortium type 2 to 5 bleeding was consistently lower with 1- than with 3-month DAPT in patients aged ≥75 years (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48 to 0.91) and <75 years (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57 to 1.29, interaction p = 0.737). In conclusion, in patients at high bleeding risk who underwent PCI, patients older and younger than 75 years derived a consistent benefit from 1- compared with 3-month DAPT in terms of bleeding reduction, with no increase in all-cause death or MI at 1 year.
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Affiliation(s)
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt & Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | | | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, New York
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Bassem M Chehab
- Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, Kansas
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas
| | - Yihan Feng
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Katherine Godfrey
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology University Heart Centre Freiburg Bad Krozingen Medical Centre - University of Freiburg, Germany
| | | | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | - Olivier Varenne
- Hôpital Cochin, APHP, Université de Paris Cité, Paris, France
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York.
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Hemetsberger R, Mankerious N, Muntané-Carol G, Temporal J, Sulimov D, Gaede L, Woitek F, Grau EF, Scalamogna M, Olschewski M, Mitsis A, Ruzsa Z, Toth GG, Heyer H, Toelg R, Gómez-Hospital JA, Mügge A, Hengstenberg C, Mangner N, Gori T, Cassese S, Suárez XC, Abdel-Wahab M, Johnson T, Richardt G, Allali A. In-hospital Outcomes of Rotational Atherectomy in ST-Elevation Myocardial Infarction: Results From the Multicentre ROTA-STEMI Network. Can J Cardiol 2023:S0828-282X(23)02034-2. [PMID: 38147962 DOI: 10.1016/j.cjca.2023.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Although the use of rotational atherectomy (RA) is off-label in the setting of ST-elevation myocardial infarction (STEMI), it can be the only option in severely calcified culprit lesions to achieve procedural success. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention (PPCI). METHODS This was a retrospective observational study of patients who underwent RA during PPCI from 12 European centres. The main outcomes were procedural success (defined as successful stent implantation with final thrombolysis in myocardial infarction [TIMI] flow 3 and residual stenosis < 30%) and in-hospital mortality. A comparison of patients presenting with and without shock was performed. RESULTS In 104 patients with RA during STEMI, the mean age was 72.8 ± 9.1 years, and 35% presented with cardiogenic shock. Bailout RA was performed in 76.9% of cases. Mean burr size was 1.42 ± 0.21 mm. Procedural success was achieved in 86.5% of cases, with no difference between shocked and nonshocked patients (94.4% vs 82.4%; P = 0.13). In-hospital stent thrombosis occurred in 0.96%, perforation in 1.9% and burr entrapment in 2.9% of cases. In spite of equally high procedural success, in-hospital mortality was higher in shocked (50%) compared with nonshocked patients (1.5%; P < 0.0001). CONCLUSIONS Patients presenting with STEMI requiring RA, represent a high-risk population, frequently presenting with cardiogenic shock. In this analysis of selected patients, RA was performed as a bailout strategy in the majority, and, as such, RA seems to be feasible with a high procedural success rate. In the absence of cardiogenic shock, RA-facilitated PCI seems to be associated with low in-hospital mortality.
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Affiliation(s)
- Rayyan Hemetsberger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Department of Cardiology, Zagazig University, Sharkia, Egypt
| | | | - Justin Temporal
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Dmitriy Sulimov
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Luise Gaede
- Medizinische Klinik 2, Department of Cardiology and Angiology, Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Felix Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Edgar Fadeuilhe Grau
- Unitat Hemodinamica i Cardiologia Intervencionista. Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Maria Scalamogna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Department of Advanced Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Maximilian Olschewski
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Zoltán Ruzsa
- Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szegad, Hungary
| | | | - Hajo Heyer
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Asklepios Clinic, Bad Oldesloe, Germany; Medical faculty of the Christian-Albrechts University of Kiel, Kiel, Germany
| | | | - Andreas Mügge
- Department of Cardiology and Angiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Christian Hengstenberg
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Xavier Carrillo Suárez
- Unitat Hemodinamica i Cardiologia Intervencionista. Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Johnson
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Asklepios Clinic, Bad Oldesloe, Germany; Medical faculty of the Christian-Albrechts University of Kiel, Kiel, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
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6
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Mihatov N, Kirtane AJ, Stoler R, Feldman R, Neumann FJ, Boutis L, Tahirkheli N, Kereiakes DJ, Toelg R, Othman I, Stein B, Allocco D, Windecker S, Yeh RW. Bleeding and Ischemic Risk Prediction in Patients With High Bleeding Risk (an EVOLVE Short DAPT Analysis). Am J Cardiol 2023; 207:370-379. [PMID: 37778226 DOI: 10.1016/j.amjcard.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 10/03/2023]
Abstract
The EVOLVE Short DAPT study demonstrated the safety of truncated dual antiplatelet therapy (DAPT) in patients with a high bleeding risk (HBR) treated with SYNERGY stent(s) (Boston Scientific Company, Marlborough, Massachusetts). In this population, bleeding and ischemic risk prediction may further inform DAPT decisions. This post hoc analysis of the EVOLVE Short DAPT study identified predictors of ischemic and bleeding events up to 15 months using Cox proportional hazard models. The predicted probabilities of bleeding were calculated using the Breslow method. Of 2,009 enrolled patients, 96.9% of the patients met at least 1 HBR criteria. At 15 months, the cumulative incidences of bleeding and ischemic events were 6.3% and 6.0%, respectively. The risk of bleeding was increased in patients who received oral anticoagulants (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.50 to 3.36, p <0.001) or had peripheral vascular disease (HR 1.61, 95% CI 1.01 to 2.56, p = 0.045). The risk of ischemic events was increased in patients with diabetes (HR 1.86, 95% CI 1.24 to 2.78, p <0.01) or congestive heart failure (HR 2.06, 95% CI 1.39 to 3.04, p <0.001). Renal insufficiency/failure was associated with both endpoints. There was a strong positive correlation between the predicted probability of ischemic and bleeding events (R = 0.77, p <0.001). In 617 patients with a predicted bleeding risk <4%, ischemic events predominated, and the ischemic and bleeding rates were higher in patients with a predicted bleeding risk ≥4%. Within an HBR cohort, specific characteristics identify patients at a higher risk for ischemic and separately, bleeding events. Increased bleeding risk is tied to increased ischemic risk. In conclusion, standardized risk models are needed to inform DAPT decisions in patients with a higher risk. Clinical Trial Registration: NCT02605447.
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Affiliation(s)
- Nino Mihatov
- New York-Presbyterian Hospital - Brooklyn Methodist & Weill Cornell Medical College, New York, New York; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Robert Stoler
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Robert Feldman
- MediQuest Research at AdventHealth Ocala, Ocala, Florida
| | | | - Loukas Boutis
- North Shore University Hospital, Manhasset, New York
| | | | - Dean J Kereiakes
- Lindner Center for Research and Education at Christ Hospital, Cincinnati, Ohio
| | - Ralph Toelg
- Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Islam Othman
- Duke University Health System, Durham, North Carolina
| | - Bernardo Stein
- Morton Plant Mease Healthcare System, Clearwater, Florida
| | | | - Stephan Windecker
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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7
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Valgimigli M, Spirito A, Sartori S, Angiolillo DJ, Vranckx P, de la Torre Hernandez JM, Krucoff MW, Bangalore S, Bhatt DL, Campo G, Cao D, Chehab BM, Choi JW, Feng Y, Ge J, Hermiller J, Kunadian V, Lupo S, Makkar RR, Maksoud A, Neumann FJ, Picon H, Saito S, Sardella G, Thiele H, Toelg R, Varenne O, Vogel B, Zhou Y, Windecker S, Mehran R. 1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI. JACC Cardiovasc Interv 2023; 16:2498-2510. [PMID: 37804290 DOI: 10.1016/j.jcin.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. OBJECTIVES The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. METHODS The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. RESULTS Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). CONCLUSIONS Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt & Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | | | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sripal Bangalore
- New York University, Grossman School of Medicine, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Gianluca Campo
- Malattie Dell'Apparato Cardiovascolare, Università degli Studi di Ferrara, Ferrara, Italy
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Bassem M Chehab
- Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, Kansas, USA
| | | | - Yihan Feng
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Sydney Lupo
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology University Heart Centre Freiburg · Bad Krozingen Medical Centre - University of Freiburg, Freiburg, Germany
| | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | | | | | - Holger Thiele
- Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany; Hospital Cochin, Paris, France
| | - Ralph Toelg
- Segeberger Kliniken, Herzzentrum, Bad Segeberg, Germany
| | | | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Hemetsberger R, Mankerious N, Toelg R, Abdelghani M, Farhan S, Garcia-Garica HM, Allali A, Windecker S, Lefèvre T, Saito S, Kandzari D, Waksman R, Richardt G. Patients with higher-atherothrombotic risk vs. lower-atherothrombotic risk undergoing coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials. Clin Res Cardiol 2023; 112:1278-1287. [PMID: 37062047 DOI: 10.1007/s00392-023-02205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with atherothrombotic risk are at high hazard of ischemic events. Preventive medicine plays a major role in modifying their outcomes. Whether the choice of a BP-SES or DP-EES can contribute to the occurrence of events remains unclear. We sought to investigate the outcomes of patients with higher atherothrombotic risk (H-ATR) versus lower atherothrombotic risk (L-ATR) undergoing percutaneous coronary intervention (PCI) with either bioresorbable-polymer sirolimus-eluting stent (BP-SES) or durable-polymer everolimus-eluting stent (DP-EES). METHODS Patients (n = 2361) from BIOFLOW-II, -IV, and -V randomized trials were categorized into H-ATR vs. L-ATR. L-ATR patients had ≤ 1 and H-ATR ≥ 2 of the following criteria: presentation in ACS, diabetes mellitus, previous myocardial infarction, previous PCI/CABG, or previous stroke. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], target lesion revascularization [TLR]) and stent thrombosis (ST) at three years. RESULTS H-ATR patients (n = 1023) were more morbid than L-ATR patients (n = 1338). TLF rate was significantly higher in H-ATR patients as compared with L-ATR (11.6% vs. 7.0%; HR 1.67, 95% CI 1.27-2.20, p < 0.0001). With BP-SES TLF rates were numerically lower as compared with DP-EES in H-ATR (10.5% vs. 13.5%; HR 0.78, 95% CI 0.54-1.14, p = 0.20) and significantly lower in L-ATR (5.6% vs. 9.8%; HR 0.57, 95% CI 0.38-0.85, p = 0.006). CONCLUSION In the era of newer-generation DES, patients with H-ATR still are at hazard for ischemic events. Patients with BP-SES had lower TLF rates as compared with DP-EES, most consistent in L-ATR whereas in H-ATR patients most probably secondary preventive strategies are of higher value. CLINICAL TRIAL REGISTRATION Clinicaltrial.gov. NCT01356888, NCT01939249, NCT02389946. https://clinicaltrials.gov/show/NCT01356888 , https://clinicaltrials.gov/show/NCT01939249 , https://clinicaltrials.gov/show/NCT02389946 .
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Affiliation(s)
- Rayyan Hemetsberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt
- Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | | | | | | | | | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Ron Waksman
- Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
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9
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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10
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Mankerious N, Megaly M, Hemetsberger R, Allali A, Samy M, Toelg R, Garcia S, Richardt G. Short Versus Long-Term Dual Antiplatelet Therapy in Patients at High Bleeding Risk Undergoing PCI in Contemporary Practice: A Systemic Review and Meta-analysis. Cardiol Ther 2023; 12:489-498. [PMID: 37261649 PMCID: PMC10423172 DOI: 10.1007/s40119-023-00318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Patients at high bleeding risk (HBR patients) represent an important subset of patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether a shortened duration of dual antiplatelet therapy (DAPT) confers benefits compared with prolonged duration of DAPT in this patient population. The aim of this study was to investigate and compare bleeding and ischemic outcomes among HBR patients receiving short- versus long-term DAPT after PCI. METHODS A meta-analysis of studies comparing short-term (1-3 months) and long-term (6-12 months) DAPT after PCI with second-generation drug-eluting stents in HBR patients was performed. RESULTS Six studies [1 randomized controlled trial (RCT), 2 RCT subanalyses, and 3 prospective propensity-matched studies] involving 15,908 patients were included in the meta-analysis. During a follow-up of 12 months, short-term DAPT was associated with a reduction in major bleeding events [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.42-0.95; p = 0.03, I2 = 71] and comparable definite/probable stent thrombosis, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and ischemic stroke, compared with long-DAPT. Single antiplatelet therapy (SAPT) with aspirin was comparable to SAPT with P2Y12 inhibitor, with no treatment-by-subgroup interaction for major bleeding events (p-interaction = 0.27). In studies including patients presenting with MI, a trend of more frequent MI was noted in the short-DAPT arm (OR 1.25, 95% CI 0.98-1.59; p = 0.07; I2 = 0). In a sensitivity analysis comparing 3- and 12-month DAPT, the 3-month DAPT strategy was associated with a higher risk of ischemic stroke (OR 2.37, 95% CI 1.15-4.87; p = 0.02, I2 = 0%). CONCLUSION Short-term DAPT after PCI in HBR patients was associated a reduction in major bleeding events and similar ischemic outcomes. However, a higher risk of ischemic stroke and MI at 1 year of follow-up was seen in some subsets.
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Affiliation(s)
- Nader Mankerious
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
- Division of Cardiology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Rayyan Hemetsberger
- Department of Cardiology and Angiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Mohamed Samy
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
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11
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Haude M, Wlodarczak A, van der Schaaf RJ, Torzewski J, Ferdinande B, Escaned J, Iglesias JF, Bennett J, Toth GG, Joner M, Toelg R, Wiemer M, Olivecrano G, Vermeersch P, Garcia-Garcia HM, Waksman R. A new resorbable magnesium scaffold for de novo coronary lesions (DREAMS 3): one-year results of the BIOMAG-I first-in-human study. EUROINTERVENTION 2023; 19:e414-e422. [PMID: 37334655 PMCID: PMC10397670 DOI: 10.4244/eij-d-23-00326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The third-generation coronary sirolimus-eluting magnesium scaffold, DREAMS 3G, is a further development of the DREAMS 2G (commercial name Magmaris), aiming to provide performance outcomes similar to drug-eluting stents (DES). AIMS The BIOMAG-I study aims to assess the safety and performance of this new-generation scaffold. METHODS This is a prospective, multicentre, first-in-human study with clinical and imaging follow-up scheduled at 6 and 12 months. The clinical follow-up will continue for 5 years. RESULTS A total of 116 patients with 117 lesions were enrolled. At 12 months, after completion of resorption, in-scaffold late lumen loss was 0.24±0.36 mm (median 0.19, interquartile range 0.06-0.36). The minimum lumen area was 4.95±2.24 mm² by intravascular ultrasound and 4.68±2.32 mm² by optical coherence tomography. Three target lesion failures were reported (2.6%, 95% confidence interval: 0.9-7.9), all clinically driven target lesion revascularisations. Cardiac death, target vessel myocardial infarction and definite or probable scaffold thrombosis were absent. CONCLUSIONS Data at the end of the resorption period of DREAMS 3G showed that the third-generation bioresorbable magnesium scaffold is clinically safe and effective, making it a possible alternative to DES. CLINICALTRIALS gov: NCT04157153.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
| | - Adrian Wlodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia SA, Lubin, Poland
| | | | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost Limburg (ZOL), Genk, Belgium
| | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Juan F Iglesias
- Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gabor G Toth
- Division of Cardiology, Medical University Graz, Graz, Austria
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany, and Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Göran Olivecrano
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | | | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
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12
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Elbasha K, Alotaibi S, Heyer H, Mankerious N, Toelg R, Geist V, Richardt G, Allali A. Predictors of long-term adverse outcomes after successful chronic total occlusion intervention: physiology or morphology? Clin Res Cardiol 2023:10.1007/s00392-023-02279-0. [PMID: 37542021 DOI: 10.1007/s00392-023-02279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and target-vessel SYNTAX score (tvSS) are novel indices used to assess lesion physiology and morphology in percutaneous coronary intervention (PCI). Their prognostic implication after successful recanalization of coronary chronic total occlusion (CTO) is unknown. OBJECTIVES To investigate the prognostic value of QFR measured immediately after successful CTO-recanalization in predicting vessel-oriented adverse events, and to compare it with the pre-procedural morphological tvSS. METHODS QFR was measured offline after successful CTO-PCIs in a single center. We grouped the patients according to a cut-off value of post-PCI QFR (0.91). The primary outcome was target-vessel failure (TVF) at 2 years. RESULTS Among 470 CTO lesions performed during the study period, 324 were eligible for QFR analysis (258 with QFR ≥ 0.91 and 66 with QFR < 0.91). The mean age of the study population was 68.3 ± 10.7 years. The low QFR group had a lower left ventricular ejection fraction (45.8 ± 13.9% vs. 49.8 ± 12.4%, p = 0.025) and a higher rate of atrial fibrillation (19.7% vs. 11.2%, p = 0.020). The mean tvSS was 12.8 ± 4.8, and it showed no significant difference in both groups (13.6 ± 5.1 vs. 12.6 ± 4.6, p = 0.122). Patients with low post-CTO QFR had a trend to develop more TVF at 2 years (21.2% vs. 12.4%, HR 1.74; 95% CI 0.93-3.25, p = 0.086). Low post-CTO QFR failed to predict 2-year TVF (aHR 1.67; 95% CI 0.85-3.29, p = 0.136), while pre-procedural tvSS was an independent predictor for 2-year TVF (aHR 1.06; 95% CI 1.01-1.13, p = 0.030). CONCLUSION We found a limited prognostic value of immediate physiological assessment using QFR after successful CTO intervention. Pre-procedure morphological characteristics of CTO lesions using tvSS can play a role in predicting long-term adverse events.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Sultan Alotaibi
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hajo Heyer
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
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Haude M, Wlodarczak A, van der Schaaf RJ, Torzewski J, Ferdinande B, Escaned J, Iglesias JF, Bennett J, Toth G, Joner M, Toelg R, Wiemer M, Olivecrona G, Vermeersch P, Garcia-Garcia HM, Waksman R. Safety and performance of the third-generation drug-eluting resorbable coronary magnesium scaffold system in the treatment of subjects with de novo coronary artery lesions: 6-month results of the prospective, multicenter BIOMAG-I first-in-human study. EClinicalMedicine 2023; 59:101940. [PMID: 37113674 PMCID: PMC10126775 DOI: 10.1016/j.eclinm.2023.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Background A third-generation coronary drug-eluting resorbable magnesium scaffold (DREAMS 3G) was developed to enhance the performance of previous scaffold generations and achieve angiographic outcomes comparable to those of contemporary drug-eluting stents. Methods This prospective, multicenter, non-randomized, first-in-human study was conducted at 14 centers in Europe. Eligible patients had stable or unstable angina, documented silent ischemia, or non-ST-elevation myocardial infarction, and a maximum of two single de novo lesions in two separate coronary arteries with a reference vessel diameter between 2.5 mm and 4.2 mm. Clinical follow-up was scheduled at one, six and 12 months and annually thereafter until five years. Invasive imaging assessments were scheduled six and 12 months postoperatively. The primary endpoint was angiographic in-scaffold late lumen loss at six months. This trial was registered at ClinicalTrials.gov (NCT04157153). Findings Between April 2020 and February 2022, 116 patients with 117 coronary artery lesions were enrolled. At six months, in-scaffold late lumen loss was 0.21 mm (SD 0.31). Intravascular ultrasound assessment showed preservation of the scaffold area (mean 7.59 mm2 [SD 2.21] post-procedure vs 6.96 mm2 [SD 2.48]) at six months) with a low mean neointimal area (0.02 mm2 [SD 0.10]). Optical coherence tomography revealed that struts were embedded in the vessel wall and were already hardly discernible at six months. Target lesion failure occurred in one (0.9%) patient; a clinically driven target lesion revascularization was performed on post-procedure day 166. No definite or probable scaffold thrombosis or myocardial infarction was observed. Interpretation These findings show that the implantation of DREAMS 3G in de novo coronary lesions is associated with favorable safety and performance outcomes, comparable to contemporary drug-eluting stents. Funding This study was funded by BIOTRONIK AG.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
- Corresponding author. Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Preussenstr. 84, 41464, Neuss, Germany.
| | - Adrian Wlodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia SA, Lubin, Poland
| | | | | | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost Limburg (ZOL), Genk, Belgium
| | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Juan F. Iglesias
- Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gabor Toth
- Division Cardiology, Medical University Graz, Graz, Austria
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital Ruhr University Bochum, Minden, Germany
| | - Göran Olivecrona
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Paul Vermeersch
- Interventional Cardiology ZNA Middelheim, Antwerpen, Belgium
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
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Allali A, Richardt G, Toelg R, Elbasha K, Sulimov DS, Kastrati A, Geist V, El-Mawardy M, Rheude T, Abdel-Wahab M. High-speed rotational atherectomy versus modified balloons for plaque preparation of severely calcified coronary lesions: two-year outcomes of the randomised PREPARE-CALC trial. EUROINTERVENTION 2023; 18:e1365-e1367. [PMID: 36579635 PMCID: PMC10068860 DOI: 10.4244/eij-d-22-00677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/21/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Tobias Rheude
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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15
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Zeymer U, Toelg R, Wienbergen H, Hobbach HP, Cuneo A, Bekeredjian R, Ritter O, Hailer B, Hertting K, Hennersdorf M, Scholtz W, Lanzer P, Mudra H, Schwefer M, Schwimmbeck PL, Liebetrau C, Thiele H, Claas C, Riemer T, Zahn R. Current status of antithrombotic therapy and in-hospital outcomes in patients with atrial fibrillation undergoing percutaneous coronary intervention in Germany. Herz 2023; 48:134-140. [PMID: 35243515 DOI: 10.1007/s00059-022-05099-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/06/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about current patterns of antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) in clinical practice in Germany. METHODS The RIVA-PCI is a prospective, non-interventional, multicenter study with follow-up until hospital discharge including consecutive patients with AF undergoing PCI. RESULTS Between January 2018 and March 2020, 1636 patients (elective in 52.6%, non-ST elevation acute coronary syndrome [NSTE-ACS] in 39.3%, ST-elevation myocardial infarction in 8.2%) from 51 German hospitals were enrolled in the study. After PCI a dual antithrombotic therapy (DAT) consisting of OAC and a P2Y12 inhibitor was given to 66.0%, triple antithrombotic therapy (TAT) to 26.0%, dual antiplatelet therapy to 5.5%, and a mono-therapy to 2.5% of the patients. Non-vitamin K antagonist oral anticoagulants (NOACs) were given to 82.4% and vitamin K antagonists to 11.5% of the patients. In-hospital events included death in 12 cases (0.7%), myocardial infarction, stent thrombosis, and ischemic stroke in four (0.2%) patients each, while 2.8% of patients had bleeding complications. The recommended durations for DAT or TAT at discharge were 1 month (1.5%), 3 months (2.1%), 6 months (43.1%), and 12 months (45.6%), with a 6-month course of DAT (47.7%) most often recommended after elective PCI and a 12-month course of DAT (40.1%) after ACS. CONCLUSION The preferred therapy after PCI in patients with AF is DAT with a NOAC and clopidogrel. In-hospital ischemic and bleeding events were rare. The recommended durations for combination therapy vary considerably.
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Affiliation(s)
- Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany. .,Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | | | | | | | | | - Birgit Hailer
- Katholische Kliniken Essen-Nord-West gGmbH, Essen, Germany
| | | | | | | | - Peter Lanzer
- Gesundheitszentrum Bitterfeld Wolfen, Bitterfeld, Germany
| | - Harald Mudra
- Städtisches Krankenhaus Neuperlach-München, München, Germany
| | | | | | | | - Holger Thiele
- Herzzentrum Leipzig und Universität Leipzig, Leipzig, Germany
| | - Christoph Claas
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Riemer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany
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Slagboom T, Toelg R, Witzenbichler B, Haude M, Masotti M, Ruiz Salmeron R, Witkowski AR, Uematus M, Takahashi A, Waksman R, Saito S. Sirolimus-eluting or everolimus-eluting stents for coronary artery disease: 5-year outcomes of the randomised BIOFLOW-IV trial. EUROINTERVENTION 2023; 18:1197-1200. [PMID: 36625005 PMCID: PMC9936249 DOI: 10.4244/eij-d-22-00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ton Slagboom
- Cardiology Unit, OLVG, Amsterdam, the Netherlands
| | - Ralph Toelg
- Herzzentrum, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Michael Haude
- Lukaskrankenhaus Medizinische Klinik I, Städtische Kliniken Neuss, Neuss, Germany
| | - Monica Masotti
- Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Masaaki Uematus
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | - Ron Waksman
- MedStar Health Research Institute, Washington, DC, USA
| | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
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Zeymer U, Toelg R, Wienbergen H, Hobbach HP, Cuneo A, Bekeredjian R, Ritter O, Hailer B, Hertting K, Hennersdorf M, Scholtz W, Lanzer P, Mudra H, Schwefer M, Schwimmbeck PL, Liebetrau C, Thiele H, Claas C, Riemer T, Zahn R. Rivaroxaban in Patients With Atrial Fibrillation Who Underwent Percutaneous Coronary Intervention in Clinical Practice. Am J Cardiol 2023; 189:31-37. [PMID: 36493580 DOI: 10.1016/j.amjcard.2022.11.009] [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] [Received: 08/25/2022] [Revised: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
Little is known about the efficacy and safety of rivaroxaban in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) in clinical practice. We therefore conducted a prospective observational study to determine the rate of ischemic, embolic, and bleeding events in patients with AF and PCI treated with rivaroxaban in a real-world experience. The RIVA-PCI ("rivaroxaban in patients with AF who underwent PCI") (clinicaltrials.gov NCT03315650) is a prospective, noninterventional, multicenter study with a follow-up until 14 months, including patients with AF who underwent PCI discharged with rivaroxaban. Between January 2018 and March 2020, 700 patients with PCI treated with rivaroxaban (elective in 50.1%, non-ST-elevation acute coronary syndrome 43.0%, ST-elevation myocardial infarction in 6.9%) were enrolled at 51 German hospitals. After PCI, a dual antithrombotic therapy consisting of rivaroxaban and a P2Y12 inhibitor was administered in 70.7% and triple antithrombotic therapy in 27.9%, respectively. Follow-up information could be obtained in 695 patients (99.3%). Rivaroxaban has been stopped prematurely in 21.6% of patients. Clinical events under rivaroxaban during the 14-month follow-up compared with those observed in the PIONEER-AF PCI trial included cardiovascular death (2.0% % vs 2.0%), myocardial infarction (0.9% vs 3.0%), stent thrombosis (0.2% vs 0.8%), stroke (1.3% vs 1.3%), International Society on Thrombosis and Haemostasis major (4.2% vs 3.9%), and International Society on Thrombosis and Haemostasis nonmajor clinically relevant bleeding (15.3% vs 12.9%). Therefore, in this real-world experience, rivaroxaban in patients with AF who underwent PCI is associated with ischemic and bleeding event rates comparable with those observed in the randomized PIONEER-AF PCI trial.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany.
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | | | | | | | | | - Birgit Hailer
- Katholische Kliniken Essen-Nord-West gGmbH, Essen, Germany
| | | | | | | | - Peter Lanzer
- Gesundheitszentrum Bitterfeld Wolfen, Bitterfeld, Germany
| | - Harald Mudra
- München Klinik, Klinikum Neuperlach, München, Germany
| | | | | | | | - Holger Thiele
- Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | | | - Thomas Riemer
- Institut für Herzinfarktforschung Ludwigshafen, Germany
| | - Ralf Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
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18
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Fitzgerald S, Gimenez MR, Allali A, Toelg R, Sulimov DS, Geist V, Kastrati A, Thiele H, Richardt G, Abdel-Wahab M. Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial. Interv Cardiol 2023; 18:e02. [PMID: 36891034 PMCID: PMC9987508 DOI: 10.15420/icr.2022.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023] Open
Abstract
Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.
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Affiliation(s)
- Sean Fitzgerald
- Heart Center Leipzig Leipzig, Germany.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences Dublin, Ireland
| | | | | | - Ralph Toelg
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | | | - Volker Geist
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich Germany
| | | | - Gert Richardt
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
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Allali A, Toelg R, Abdel-Wahab M, Hemetsberger R, Kastrati A, Mankerious N, Traboulsi H, Elbasha K, Rheude T, Landt M, Geist V, Richardt G. Combined rotational atherectomy and cutting balloon angioplasty prior to drug-eluting stent implantation in severely calcified coronary lesions: The PREPARE-CALC-COMBO study. Catheter Cardiovasc Interv 2022; 100:979-989. [PMID: 36262074 DOI: 10.1002/ccd.30423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of lesion preparation using rotational atherectomy (RA) with consecutive cutting balloon angioplasty (Rota-Cut). BACKGROUND Whether the Rota-Cut combination improves stent performance in severely calcified coronary lesions is unknown. METHODS PREPARE-CALC-COMBO is a single-arm prospective trial in which 110 patients were treated with a Rota-Cut strategy before implantation of sirolimus-eluting stents and compared with patients treated with modified balloon (MB, scoring or cutting) or RA from a historical cohort (the randomized PREPARE-CALC trial). The study had two primary endpoints: in-stent acute lumen gain (ALG) by quantitative angiographic analysis and stent expansion (SE) on optical coherence tomography. RESULTS In-stent ALG was significantly higher with Rota-Cut compared to RA or MB alone (1.92 ± 0.45 mm vs. 1.74 ± 0.45 mm with MB vs. 1.70 ± 0.42 mm with RA; p = 0.001 and p < 0.001, respectively). SE was comparable between groups (75.1 ± 13.8% vs. 73.5 ± 13.3 with MB vs. 73.1 ± 12.2 with RA; p = 0.19 and p = 0.39, respectively). The Rota-Cut combination resulted in higher minimal stent area (MSA) (7.1 ± 2.2mm2 vs. 6.1 ± 1.7mm2 with MB vs. 6.2 ± 1.9mm2 with RA; p = 0.003 and p = 0.004, respectively). In-hospital death occurred in one patient. Target vessel failure at 9 months was low and comparable between groups (8.2% vs. 8% with MB vs. 6% with RA; p = 1 and p = 0.79, respectively). CONCLUSION Rota-Cut combination resulted in higher ALG and larger MSA compared with historical control of RA or MB alone, but was not associated with higher SE. Despite extensive lesion preparation, this strategy is safe, feasible, and associated with favorable clinical outcome at 9 months.
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Affiliation(s)
- Abdelhakim Allali
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Rayyan Hemetsberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | | | - Karim Elbasha
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.,Cardiology Department, Faculty of Medicine, Zagazig university, Zagazig, Egypt
| | - Tobias Rheude
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Volker Geist
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
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20
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Rheude T, Fitzgerald S, Allali A, Mashayekhi K, Gori T, Cuculi F, Kufner S, Hemetsberger R, Sulimov DS, Rai H, Ayoub M, Bossard M, Xhepa E, Fusaro M, Toelg R, Joner M, Byrne RA, Richardt G, Kastrati A, Cassese S, Abdel-Wahab M. Rotational Atherectomy or Balloon-Based Techniques to Prepare Severely Calcified Coronary Lesions. JACC Cardiovasc Interv 2022; 15:1864-1874. [PMID: 36137691 DOI: 10.1016/j.jcin.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The comparative efficacy of percutaneous techniques for the preparation of calcified lesions before stenting remains poorly studied. OBJECTIVES This study sought to compare the performance of up-front rotational atherectomy (RA) or balloon-based techniques before drug-eluting stent implantation in severely calcified coronary lesions as assessed by angiography and optical coherence tomography (OCT). METHODS Patient-level data from the PREPARE-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) and ISAR-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) randomized trials were pooled. The primary endpoint was stent expansion as assessed by OCT imaging. The secondary endpoints included stent eccentricity, stent asymmetry, angiographic acute lumen gain, strategy success and in-hospital occurrence of cardiac death, target vessel myocardial infarction, and repeat revascularization. RESULTS Among 274 patients originally randomized, 200 participants with available OCT data after lesion preparation with RA (n = 63), a modified balloon (MB, n = 103), or a super high-pressure balloon (n = 34) before stenting were analyzed. The use of RA versus MB or a super high-pressure balloon led to comparable stent expansion (73.2% ± 11.6% vs 70.8% ± 13.6% vs 71.8% ± 12.2%, P = 0.49) and stent asymmetry (P = 0.83). Compared with RA or MB, a super high-pressure balloon was associated with less stent eccentricity (P = 0.03) with a numerically higher acute lumen gain, albeit not significantly different (P = 0.08). Strategy success was more frequent with RA versus MB (P = 0.002) and numerically more frequent with RA versus a super high-pressure balloon (P = 0.06). Clinical outcomes did not differ between groups. CONCLUSIONS In patients with severely calcified lesions undergoing drug-eluting stent implantation, lesion preparation with RA, MB, or a super high-pressure balloon was associated with comparable stent expansion. A super high-pressure balloon is associated with less stent eccentricity, whereas strategy success is more frequent with RA.
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Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Sean Fitzgerald
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| | - Florim Cuculi
- Department of Cardiology, Kantonspital Luzern, Switzerland
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Rayyan Hemetsberger
- Klinik für Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Dmitriy S Sulimov
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Himanshu Rai
- Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mohamed Ayoub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Massimiliano Fusaro
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Klinik für Kardiologie und Angiologie, Zollernalb-Klinikum, Albstadt, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Gert Richardt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany.
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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21
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Abdelghani M, Hemetsberger R, Landt M, Zachow D, Beurich HW, Toelg R, Abdel-Wahab M, Richardt G, Merten C. Impact of Prosthetic Valve Regurgitation Assessed by Echocardiography and Magnetic Resonance Imaging on Long-term Clinical Outcomes after TAVR. Cardiology 2022; 147:461-468. [PMID: 35947973 DOI: 10.1159/000526336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prosthetic valve regurgitation (PVR) impairs early and mid-term outcomes after transcatheter aortic valve replacement (TAVR). We explored the impact of PVR assessed by transthoracic echocardiography (TTE) and magnetic resonance imaging-regurgitation fraction (MRI-RF) on long-term clinical outcomes. METHODS PVR was assessed by TTE applying the Valve Academic Research Consortium criteria and MRI-RF (from velocity-encoded phase contrast magnetic resonance sequence) in 424 patients. RESULTS MRI-RF correlated modestly with the echocardiographic grades of PVR (Spearman's rank correlation coefficient= 0.32, p<0.001). Using an MRI-RF≥20% to define ≥moderate PVR, echocardiography and MRI-RF agreed on PVR classification in 412 patients (97.2%; kappa statistic = 0.56, p<0.001). Five-year mortality or reintervention was higher in patients with echocardiographic ≥moderate PVR (83.3% vs. 45.0%, log rank p value= 0.002; HR[95% CI]: 3.18[1.48-6.84]) as well as in patients with MRI-RF≥20% (79.3% vs. 43.2%, log rank p value <0.001; HR[95% CI]: 2.68[1.53-4.70])); while the outcomes of patients with echocardiographic mild PVR was not significantly different from those with none-trace PVR. In the two latter groups (echocardiographic <moderate PVR), MRI-RF≥20% was associated with a significantly higher five-year mortality or reintervention as compared with MRI-RF<20% (79.5% vs. 42.2%, log rank p value=0.023; HR[95% CI]: 2.26[1.10-4.65]). CONCLUSIONS Greater than mild PVR as defined by TTE or MRI-RF is associated with impaired long-term clinical outcomes after TAVR. MRI-RF can be used to further risk-stratify patients with echocardiographic less-than-moderate PVR.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt
- Cardiology Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Martin Landt
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Dirk Zachow
- Department of Radiology, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Ralph Toelg
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gert Richardt
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
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22
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Alotaibi S, Elbasha K, Landt M, Kaur J, Kurniadi A, Abdel-Wahab M, Toelg R, Richardt G, Allali A. Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation. Cureus 2022; 14:e27152. [PMID: 36017287 PMCID: PMC9393071 DOI: 10.7759/cureus.27152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background The HFA-PEFF score may help in predicting long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and preserved left ventricular ejection fraction (EF). Methods We retrieved data from 1,332 patients undergoing TAVI between 2010 and 2019 from the Prospective Segeberg TAVI Registry (ClinicalTrials.gov Identifier: NCT03192774). We calculated the HFA-PEFF score for 1,022 patients who had preserved EF (≥50%). To assess the prognostic value of the HFA-PEFF score in predicting adverse events, we dichotomised the patients according to a cut-off score of five (score <5 group: n=528 (51.6%), score ≥5 group: n=494 (48.3%)). Results The HFA-PEFF score ≥5 groups were older (81.9±6.3 years vs. 80.3±6.9 years; p<0.001) and had a higher prevalence of atrial fibrillation (35.1% vs 20.8%; p<0.001) and chronic kidney disease (30.1% vs 26.1%; p<0.001). Kaplan-Meier survival analyses over 24 months showed increased cardiovascular (CV) mortality (12.5% vs. 7.7%, log-rank; p=0.028) and first heart failure-related rehospitalisation (7.7% vs. 4.0%, log-rank p=0.014) in the HFA-PEFF score ≥5 groups compared with those of lower scores. No significant difference in all-cause mortality between both groups was observed (22.0% vs. 17.9%, log-rank p=0.127). In multivariate analysis, HFA-PEFF score ≥5 failed to predict CV mortality (aHR 1.37, 95% CI: 0.90-2.08, p=0.140) and time to first heart failure-related rehospitalisation (aHR 1.49, 95% CI: 0.83-2.65, p=0.181). Conclusion The HFA-PEFF score showed limited value in predicting long-term mortality and adverse heart failure-related events in patients with preserved EF undergoing TAVI. Clinical variables specific to this population could complement the HFA-PEFF score for better risk prediction.
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23
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Fitzgerald S, Allali A, Toelg R, Sulimov DS, Geist V, Kastrati A, Thiele H, Neumann FJ, Richardt G, Abdel-Wahab M. Angiographic predictors of unplanned rotational atherectomy in complex calcified coronary artery disease: a pooled analysis from the randomised ROTAXUS and PREPARE-CALC trials. EUROINTERVENTION 2022; 17:1506-1513. [PMID: 34609284 PMCID: PMC9896390 DOI: 10.4244/eij-d-21-00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Calcified coronary lesions present therapeutic challenges for the interventional cardiologist, often requiring rotational atherectomy (RA). AIMS This study aimed to develop an angiographic scoring tool to predict the need for a priori RA. METHODS A pooled analysis of the randomised ROTAXUS and PREPARE-CALC studies was carried out, (N=220 patients, N=313 lesions), by virtue of the fact that both studies made provision for crossover to RA (from balloon dilatation or modified balloon dilatation, respectively). Logistical regression techniques were employed to assess for the presence of patient- or lesion-specific factors leading to a necessity for RA. External validation was performed though retrospective calculation of the score for 192 patients who underwent bail-out RA in a single centre. RESULTS Lesion length (odds ratio [OR] 1.02, 95% confidence interval [CI]: 1.00-1.04 per mm, p=0.04), bifurcation lesion (OR 2.60, 95% CI: 1.27-5.30, p=0.009), vessel tortuosity >45° (OR 3.49, 95% CI: 1.73-7.03, p<0.001) and severe vessel calcification (OR 11.60, 95% CI: 3.40-39.64, p<0.001) were predictive of the need for RA in multivariate analysis. Based on the regression coefficients, a scoring system was devised. The greater the score, the more likely a lesion required RA. The scoring system performed well in the external validation cohort, with 78% of patients crossing over having a score of greater than the proposed cut-off of 3. CONCLUSIONS We provide an angiographic scoring tool to support the expeditious use of time and resources, allowing assessment of the likelihood of success of a balloon-based strategy, or the necessity for RA.
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Affiliation(s)
- Sean Fitzgerald
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Ralph Toelg
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Volker Geist
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Holger Thiele
- University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Gert Richardt
- Heart Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Centre Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr. 39, 04289 Leipzig, Germany
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24
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Hemetsberger R, Abdelghani M, Toelg R, Garcia-Garcia HM, Farhan S, Mankerious N, Elbasha K, Allali A, Windecker S, Lefèvre T, Saito S, Kandzari D, Waksman R, Richardt G. Complex vs. non-complex percutaneous coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials. Clin Res Cardiol 2022; 111:795-805. [PMID: 35212802 DOI: 10.1007/s00392-022-01994-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing complex percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation coronary stents. AIM We sought to compare the clinical outcomes after complex PCI with a bioresorbable-polymer sirolimus-eluting stent (BP-SES) versus a durable-polymer everolimus-eluting stent (DP-EES). METHODS Patients (n = 2350) from BIOFLOW-II, -IV, and -V randomized trials were categorized into non-complex PCI vs. complex PCI. Complex PCI had at least one of the following criteria: multi-vessel PCI, ≥ 3 lesions treated, ≥ 3 stents implanted, total stent length ≥ 60 mm. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], or target lesion revascularization [TLR]) and probable/definite stent thrombosis (ST) at three years. RESULTS Patients with complex PCI (n = 348) were older and presented more often with acute coronary syndrome than non-complex PCI patients (n = 2002). Complex PCI lesions were more often type B2/C and bifurcation lesions and required more pre- and post-dilatation. Complex PCI patients had higher rates of TLF (14.6% vs. 8.1%; aHR 1.89, 95% CI [1.31-2.73], p = 0.001), TV-MI (10.2% vs. 4.4%, aHR 2.17, 95% CI [1.40-3.37], p = 0.001), and ST (1.5% vs. 0.4%, p = 0.025) as compared with non-complex PCI. TLF was not lower with BP-SES as compared to DP-EES in complex PCI (12.6% vs 18.2%, p = 0.16). CONCLUSION Patients undergoing complex PCI with the newer-generation DES still sustain a higher risk of TLF, TV-MI and stent thrombosis as compared with non-complex PCI. This adverse outcome was not significantly modified by the stent platform (BP-SES vs. DP-EES). CLINICAL TRIAL REGISTRATION Clinicaltrial.gov NCT01356888, NCT01939249, NCT02389946, https://clinicaltrials.gov/show/NCT01356888 ; https://clinicaltrials.gov/show/NCT01939249 ; https://clinicaltrials.gov/show/NCT02389946 .
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Affiliation(s)
- Rayyan Hemetsberger
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany. .,Department of Cardiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany.
| | - Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt.,Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Karim Elbasha
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | | | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Ron Waksman
- Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
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25
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Hemetsberger R, Richardt G, Lahu S, Valina C, Menichelli M, Abdelghani M, Wöhrle J, Toelg R, Witzenbichler B, Mankerious N, Liebetrau C, Bernlochner I, Hamm CW, Allali A, Joner M, Fusaro M, Xhepa E, Hapfelmeier A, Kufner S, Sager HB, Schüpke S, Laugwitz KL, Schunkert H, Neumann FJ, Kastrati A, Cassese S. Access route and clinical outcomes after ticagrelor versus prasugrel in patients with acute coronary syndrome undergoing invasive treatment strategy. Cardiovascular Revascularization Medicine 2022; 41:122-128. [DOI: 10.1016/j.carrev.2021.12.029] [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] [Received: 08/29/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
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26
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Valgimigli M, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, Choi JW, Campo G, De la Torre Hernandez JM, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Zhou Y, Krucoff MW, Ruster K, Zheng Y, Mehran R. Duration of Dual Antiplatelet Therapy for Patients at High Bleeding Risk Undergoing PCI. J Am Coll Cardiol 2021; 78:2060-2072. [PMID: 34794687 DOI: 10.1016/j.jacc.2021.08.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) among patients at high bleeding risk (HBR) is unknown. OBJECTIVES The purpose of this analysis was to compare 1 vs 3 months of DAPT in HBR patients undergoing drug-eluting stent implantation. METHODS The XIENCE Short DAPT program comprised 3 prospective, multicenter, single-arm studies of HBR patients treated with a short DAPT course followed by aspirin monotherapy after PCI with a cobalt-chromium everolimus-eluting stent. In this exploratory analysis, patients who received 1-month DAPT (XIENCE 28 USA and 28 Global) were compared with those on 3-month DAPT (XIENCE 90) using propensity score stratification. Ischemic and bleeding outcomes were assessed between 1 and 12 months after index PCI. RESULTS A total of 3,652 patients were enrolled and 1,392 patients after 1-month DAPT and 1,972 patients after 3-month DAPT were eligible for the analyses. The primary endpoint of all-cause mortality or myocardial infarction was similar between the 2 groups (7.3% vs 7.5%; difference -0.2%; 95% CI: -2.2% to 1.7%; P = 0.41). The key secondary endpoint of BARC (Bleeding Academic Research Consortium) type 2-5 bleeding was lower with 1-month DAPT compared with 3-month DAPT (7.6% vs 10.0%; difference -2.5%; 95% CI: -4.6% to -0.3%; P = 0.012). Major BARC type 3-5 bleeding did not differ at 12 months (3.6% vs 4.7%; difference -1.1%; 95% CI: -2.6% to 0.4%; P = 0.082), but was lower with 1-month DAPT at 90 days (1.0% vs 2.1%; P = 0.015). CONCLUSIONS Among HBR patients undergoing PCI, 1 month of DAPT, compared with 3 months of DAPT, was associated with similar ischemic outcomes and lower bleeding risk. (XIENCE 90 Study; NCT03218787; XIENCE 28 USA Study; NCT03815175; XIENCE 28 Global Study; NCT03355742).
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sripal Bangalore
- New York University-Langone Medical Center, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - James Hermiller
- St Vincent's Medical Center of Indiana, Indianapolis, Indiana, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | | | - James W Choi
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Gianluca Campo
- Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Pascal Vranckx
- Heart Centre Hasselt and University of Hasselt, Hasselt, Belgium
| | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Yan Zheng
- Abbott, Santa Clara, California, USA
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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27
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Toelg R, Slagboom T, Waltenberger J, Lefèvre T, Saito S, Kandzari DE, Koolen J, Richardt G. Individual patient data analysis of the BIOFLOW study program comparing safety and efficacy of a bioresorbable polymer sirolimus eluting stent to a durable polymer everolimus eluting stent. Catheter Cardiovasc Interv 2021; 98:848-856. [PMID: 32890442 PMCID: PMC9292184 DOI: 10.1002/ccd.29254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/11/2020] [Accepted: 08/08/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This analysis of pooled individual patient data (IPD) aimed to evaluate the safety and efficacy of a bioresorbable polymer sirolimus eluting stent system (BP-SES; Orsiro) compared to a durable polymer everolimus eluting stent system (DP-EES; Xience) in the pooled population as well as in subgroups. METHODS IPD with up to 12 months follow-up of the randomized controlled trials BIOFLOW-II (NCT01356888), -IV (NCT01939249), and -V (NCT02389946) as well as the all comers registry BIOFLOW-III (NCT01553526) were pooled. A total of 3,717 subjects (2,923 in BP-SES and 794 in DP-EES) with 5,328 lesions (4,225 lesions in BP-SES and 1,103 in DP-EES) were included in the IPD. The primary endpoint was target lesion failure (TLF) at 12 months follow-up. Subgroups analyzed included diabetes, age (≥65 years), gender, complex lesions (B2/C), small vessels (reference vessel diameter ≤2.75 mm), multivessel treatment, renal disease, and patients with acute coronary syndrome. RESULTS Overall, TLF at 12 months was significantly lower with 5.2%in the BP-SES group versus 7.6% in the DP-EES group (p = .0098). Similarly, target vessel myocardial infarction (TV-MI) was 3.1 versus 5.7% (p = .0005). The rate of stent thrombosis was similar in both groups (0.004%). By regression analysis, an independent stent effect in favor of BP-SES was observed for TLF (p = .0043) and TV-MI (p = .0364) in small vessels. CONCLUSION Results of this IPD analysis suggest that the BP-SES with ultrathin struts is as safe as and more efficacious than DP-EES in the overall cohort and especially in small vessels.
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Affiliation(s)
- Ralph Toelg
- HerzzentrumSegeberger Kliniken GmbHBad SegebergGermany
| | | | | | | | - Shigeru Saito
- Department of CardiologyOkinawa Tokushukai Shonan Kamakura General HospitalKamakuraJapan
| | | | | | - Gert Richardt
- HerzzentrumSegeberger Kliniken GmbHBad SegebergGermany
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28
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Hemetsberger R, Abdelghani M, Toelg R, Garcia-Garcia H, Farhan S, Elbasha K, Allali A, Windecker S, Lefevre T, Saito S, Kandzari D, Waksman R, Richardt G. TCT-115 Complex Versus Noncomplex Percutaneous Coronary Intervention With Newer-Generation Drug-Eluting Stents: An Analysis From the Randomized BIOFLOW Trials. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Mehran R, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, De la Torre Hernandez JM, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Zhou Y, Krucoff MW, Ruster K, Wang J, Valgimigli M. 3- or 1-Month DAPT in Patients at High Bleeding Risk Undergoing Everolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2021; 14:1870-1883. [PMID: 34503737 DOI: 10.1016/j.jcin.2021.07.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate 2 abbreviated dual-antiplatelet therapy (DAPT) regimens in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). BACKGROUND Current-generation drug-eluting stents are preferred over bare-metal stents for HBR patients, but their optimal DAPT management remains unknown. METHODS The XIENCE Short DAPT program included 3 prospective, multicenter, single-arm studies enrolling HBR patients who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. After 1 month (XIENCE 28 USA and XIENCE 28 Global) or 3 months (XIENCE 90) of DAPT, event-free patients discontinued the P2Y12 inhibitor. The postmarketing approval XIENCE V USA study was used as historical control in a propensity score-stratified analysis. RESULTS A total of 3,652 patients were enrolled. The propensity-adjusted rate of the primary endpoint of all-cause mortality or myocardial infarction was 5.4% among 1,693 patients on 3-month DAPT versus 5.4% in the 12-month DAPT historical control (Pnoninferiority = 0.0063) and 3.5% among 1,392 patients on 1-month DAPT versus 4.3% in the 6-month DAPT historical control (Pnoninferiority = 0.0005). Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding was not significantly lower with 3- or 1-month DAPT, while BARC types 3 to 5 bleeding was reduced in both experimental groups. The rate of definite or probable stent thrombosis was 0.2% in XIENCE 90 (P < 0.0001 for the performance goal of 1.2%) and 0.3% in XIENCE 28. CONCLUSIONS Among HBR patients undergoing PCI with cobalt-chromium everolimus-eluting stents, DAPT for 1 or 3 months was noninferior to 6 or 12 months of DAPT for ischemic outcomes and may be associated with less major bleeding and a low incidence of stent thrombosis.
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Affiliation(s)
- Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sripal Bangalore
- New York University Langone Medical Center, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - James Hermiller
- St. Vincent's Medical Center of Indiana, Indianapolis, Indiana, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | - Ralph Toelg
- Segeberger Kliniken, Herzzentrum, Bad Segeberg, Germany
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | | | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Pascal Vranckx
- Heart Centre Hasselt and University of Hasselt, Hasselt, Belgium
| | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Jin Wang
- Abbott, Santa Clara, California, USA
| | - Marco Valgimigli
- Cardiocentro Ticino, Lugano and Bern University Hospital, Bern, Switzerland
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30
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Haude M, Toelg R, Lemos PA, Christiansen EH, Abizaid A, von Birgelen C, Neumann FJ, Wijns W, Ince H, Kaiser C, Lim ST, Escaned J, Eeckhout E, Garcia-Garcia HM, Waksman R. Sustained safety and performance of a second-generation sirolimus-eluting absorbable metal scaffold: Long-term data of the BIOSOLVE-II first-in-man trial at 5 years. Cardiovasc Revasc Med 2021; 38:106-110. [PMID: 34364807 DOI: 10.1016/j.carrev.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Permanent drug-eluting stents are associated with a steady increase of late complications attributed to persistent inflammation and poor vessel remodelling. Bioresorbable scaffolds have been developed to overcome such long-term limitations by providing temporary vessel support and disappearing thereafter. We aimed to assess the long-term outcomes of an absorbable metallic scaffold at 5 years. METHODS BIOSOLVE-II is an international, multi-centre, first-in-human study assessing the safety and performance of the sirolimus-eluting absorbable metal scaffold DREAMS 2G (commercial name Magmaris) in patients with a maximum of two de novo lesions. After 3 years, follow-up was extended to 5 years with the endpoints target lesion failure and rate of definite or probable stent thrombosis. RESULTS 123 patients with 123 lesions were enrolled. Lesions were 12.6 ± 4.5 mm long and 2.7 ± 0.4 mm in diameter, 43.4% were class B2/C lesions, and calcification was moderate to severe in 10.6%. At 5 years, 5.4% of patients had stable angina and 94.6% had no symptoms or ischemia. Target lesion failure rate was 8.0% [95% CI:4.2;14.9], reflecting 2 cardiac deaths, 2 target-vessel myocardial infarction, and 6 clinically-driven target lesion revascularizations. Only one target lesion failure occurred beyond 3 years; a target-vessel myocardial infarction with clinically-driven TLR on post-procedure day 1157. One additional non-cardiac death beyond 3 years due to renal failure was reported on day 1777. No definite or probable scaffold thrombosis was observed. CONCLUSION The Magmaris scaffold showed favourable long-term safety and clinical performance with low target lesion failure rates and absence of definite or probable scaffold thrombosis throughout 5 years. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II is a prospective, multi-centre, first-in-man trial enrolling 123 patients with de novo coronary artery lesions. Target lesion failure rate at 5 years was low (8.0%), including 2 cardiac deaths, 2 target-vessel myocardial infarction and 6 clinically-driven target lesion revascularizations. No definite or probable scaffold thrombosis was observed.
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Affiliation(s)
- Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany.
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Christoph Kaiser
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Eric Eeckhout
- CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Allali A, Traboulsi H, Sulimov DS, Abdel-Wahab M, Woitek F, Mangner N, Hemetsberger R, Mankerious N, Elbasha K, Toelg R, Richardt G. Feasibility and safety of minimal-contrast IVUS-guided rotational atherectomy for complex calcified coronary artery disease. Clin Res Cardiol 2021; 110:1668-1679. [PMID: 34255133 DOI: 10.1007/s00392-021-01906-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the feasibility and safety of minimal-contrast percutaneous coronary intervention (PCI) using rotational atherectomy (RA) in patients with severe coronary calcification at high-risk of contrast-associated acute kidney injury (AKI). METHODS Twenty-six patients with advanced chronic kidney disease undergoing PCI with RA at three high-volume centres were included. Baseline intravascular ultrasound (IVUS) was performed to assess lesion morphology, and to guide burr-, balloon-, and stent-selection. Final result was assessed by IVUS and angiographically. Feasibility and safety were determined by procedural and in-hospital complications, and efficacy was assessed by freedom from contrast-associated AKI after PCI. Procedural and in-hospital outcome was compared to a propensity-matched population of standard RA PCI. RESULTS Mean glomerular filtration rate was 32 ± 17 ml/min/1.73 m2. In seven cases PCI was performed in the setting of acute coronary syndrome. The left main coronary artery was treated in 27.8% and a two-stent bifurcation technique in 44.4%. RA was more often performed electively compared to the standard RA cohort (92.3 vs. 50%; p = 0.0016). Angiographic success was achieved in 100% and documented with a median contrast amount of 12.5 ml [Range 4-43]. No in-hospital death or myocardial infarction was reported. Contrast-associated AKI occurred in one patient versus five patients in standard RA group (p = 0.19). Shorter fluoroscopy time and lower radiation dose were achieved as compared to standard RA. CONCLUSION A minimal-contrast RA approach with IVUS-guidance for treatment of complex calcified coronary lesions is feasible and safe with high success rate.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
| | - Hussein Traboulsi
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Felix Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Rayyan Hemetsberger
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
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Hemetsberger R, Abdelghani M, Toelg R, Mankerious N, Allali A, Garcia-Garcia HM, Windecker S, Lefèvre T, Saito S, Slagboom T, Kandzari D, Koolen J, Waksman R, Richardt G. Impact of Coronary Calcification on Clinical Outcomes After Implantation of Newer-Generation Drug-Eluting Stents. J Am Heart Assoc 2021; 10:e019815. [PMID: 34056911 PMCID: PMC8477856 DOI: 10.1161/jaha.120.019815] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Percutaneous coronary intervention of calcified lesions was associated with worse outcomes in the era of bare‐metal and first‐generation drug‐eluting stents. Data on percutaneous coronary intervention of calcified lesions with newer‐generation drug‐eluting stents are scarce. Therefore, we investigated the impact of lesion calcification on clinical outcomes in patients undergoing percutaneous coronary intervention with a bioresorbable‐polymer sirolimus‐eluting stent or a durable‐polymer everolimus‐eluting stent. Methods and Results Patients (n=2361) from BIOFLOW II, IV, and V trials were categorized into moderate/severe versus none/mild lesion calcification by a core laboratory. End points were target‐lesion failure (TLF) (cardiac death, target‐vessel myocardial infarction, or target‐lesion revascularization) and probable/definite stent thrombosis at 2 years. The agreement in calcification assessment between the operator and the core laboratory was weak (weighted κ, 0.23). Patients with moderate/severe calcification (n=303; 16%) had higher TLF (13.5% versus 8.4%; P=0.003) and stent thrombosis rates (2.1% versus 0.2%; P<0.0001), whereas target‐lesion revascularization was not different between the groups (5.0% versus 3.9%; P=0.302). After adjustment, calcification did not emerge as an independent predictor of TLF (adjusted hazard ratio [aHR], 1.37; 95% CI, 0.89–2.08; P=0.148) but did for target‐vessel myocardial infarction (aHR, 1.66; 95% CI, 1.03–2.68; P=0.037). TLF rates were similar between bioresorbable‐polymer sirolimus‐eluting stent and durable‐polymer everolimus‐eluting stent (12.6% versus 15.4%, P=0.482) in moderate/severe calcification. In none/mild calcification, the bioresorbable‐polymer sirolimus‐eluting stent showed lower TLF (7.5% versus 10.3%, P=0.045). Conclusions With newer‐generation drug‐eluting stents, moderate/severe lesion calcification was not associated with more TLF after adjustment for the higher risk of patients with coronary calcification, whereas the rate of target‐vessel myocardial infarction was higher. The bioresorbable‐polymer sirolimus‐eluting stent and durable‐polymer everolimus‐eluting stent were equally effective and safe in calcified lesions. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01356888, NCT01939249, NCT02389946.
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Affiliation(s)
| | - Mohammad Abdelghani
- Cardiology Department Al-Azhar University Cairo Egypt.,Cardiology Department Amsterdam University Medical CenterUniversity of Amsterdam the Netherlands
| | - Ralph Toelg
- Heart Center Bad Segeberg Segeberger Kliniken GmbH Bad Segeberg Germany
| | - Nader Mankerious
- Heart Center Bad Segeberg Segeberger Kliniken GmbH Bad Segeberg Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg Segeberger Kliniken GmbH Bad Segeberg Germany
| | | | | | | | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital Kamakura Japan
| | - Ton Slagboom
- Onze Lieve Vrouwe Gasthuis Amsterdam the Netherlands
| | | | | | - Ron Waksman
- Medstar Washington Hospital Center Washington DC
| | - Gert Richardt
- Heart Center Bad Segeberg Segeberger Kliniken GmbH Bad Segeberg Germany
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33
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Kirtane AJ, Stoler R, Feldman R, Neumann FJ, Boutis L, Tahirkheli N, Toelg R, Othman I, Stein B, Choi JW, Windecker S, Yeh RW, Dauerman HL, Price MJ, Underwood P, Allocco D, Meredith I, Kereiakes DJ. Primary Results of the EVOLVE Short DAPT Study: Evaluation of 3-Month Dual Antiplatelet Therapy in High Bleeding Risk Patients Treated With a Bioabsorbable Polymer-Coated Everolimus-Eluting Stent. Circ Cardiovasc Interv 2021; 14:e010144. [PMID: 33641374 DOI: 10.1161/circinterventions.120.010144] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York (A.J.K.)
| | - Robert Stoler
- Baylor Scott & White Heart and Vascular Hospital, Dallas, TX (R.S., J.W.C.)
| | | | - Franz-Josef Neumann
- University of Freiburg, Universitats-Herzzentrum Freiburg, Bad Krozingen, Germany (F.-J.N.)
| | - Loukas Boutis
- North Shore University Hospital, Manhasset, NY (L.B.)
| | | | - Ralph Toelg
- Herzzentrum Segeberger Kliniken, Bad Segeberg, Germany (R.T.)
| | - Islam Othman
- Duke University Health System, Durham, NC (I.O.)
| | - Bernardo Stein
- Morton Plant Mease Healthcare System, Clearwater, FL (B.S.)
| | - James W Choi
- Baylor Scott & White Heart and Vascular Hospital, Dallas, TX (R.S., J.W.C.)
| | - Stephan Windecker
- Bern University Hospital, Inselspital, University of Bern, Switzerland (S.W.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | | | | | - Paul Underwood
- Boston Scientific Corporation, Marlborough, MA (P.U., D.A., I.M.)
| | - Dominic Allocco
- Boston Scientific Corporation, Marlborough, MA (P.U., D.A., I.M.)
| | - Ian Meredith
- Boston Scientific Corporation, Marlborough, MA (P.U., D.A., I.M.)
| | - Dean J Kereiakes
- Lindner Center for Research and Education at Christ Hospital, Cincinnati, OH (D.J.K.)
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Hemetsberger R, Gori T, Toelg R, Byrne R, Allali A, El-Mawardy M, Rheude T, Weissner M, Sulimov DS, Robinson DR, Richardt G, Abdel-Wahab M. Optical Coherence Tomography Assessment in Patients Treated With Rotational Atherectomy Versus Modified Balloons: PREPARE-CALC OCT. Circ Cardiovasc Interv 2021; 14:e009819. [PMID: 33641372 DOI: 10.1161/circinterventions.120.009819] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Rayyan Hemetsberger
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (R.H., R.T., A.A., G.R.)
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Germany (T.G., M.W.)
| | - Ralph Toelg
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (R.H., R.T., A.A., G.R.)
| | | | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (R.H., R.T., A.A., G.R.)
| | - Mohamed El-Mawardy
- Department of Cardiology, Vivantes Wenckebach Hospital, Berlin, Germany (M.E.-M.)
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, Germany (T.R.)
| | - Melissa Weissner
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Germany (T.G., M.W.)
| | - Dmitriy S Sulimov
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (D.S.S., M.A.-W.)
| | - Derek R Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom (D.R.R.)
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (R.H., R.T., A.A., G.R.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (D.S.S., M.A.-W.)
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35
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Iden L, Richardt G, Weinert R, Groschke S, Toelg R, Borlich M. Typical atrial flutter but not fibrillation predicts coronary artery disease in formerly healthy patients. Europace 2021; 23:1227-1236. [PMID: 33611584 DOI: 10.1093/europace/euab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/06/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Long-term mortality after ablation of typical atrial flutter has been found to be increased two-fold in comparison to atrial fibrillation ablations through a period of 5 years with unclear mechanism. METHODS AND RESULTS We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of AF was the first manifestation of cardiac disease. According to the clinical standards of our centre, the routine recommendation was to evaluate for coronary artery disease (CAD) by invasive angiogram or computed tomography scan. We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed. Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9 years in AFL vs. 63.2 years in AFIB; P = 0.15), body mass index (BMI; 28.8 vs. 28.5 kg/m2; P = 0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; P = 0.35), smoking status (22.2% smokers vs. 28.4%; P = 0.23), and renal function (GFR >60 mL/min in 96.7% of all patients vs. 95.7%; P = 0.76). There were significantly lower values for left ventricular ejection fraction (52.5% vs. 59.7%; P < 0.001), female sex (17.0% vs. 47.5%; P < 0.001), hyperlipidaemia (37.9% vs. 58.9%; P < 0.001), and family history of cardiovascular disease (CVD) (15.0 vs. 31.9%; P = 0.001) in the AFL vs. AFIB cohorts. Coronary artery disease with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (P < 0.001). Coronary artery disease with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (P < 0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (P < 0.001). After correction for age, left ventricular ejection fraction, BMI, CHA2DS2-VASc-Score and its individual components, smoking status, hyperlipidaemia, and family history of CVD, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB [odds ratio (OR 5.26)]. A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; P = 0.001), had a higher number of risk factors (3.08 vs. 2.24; P ≤ 0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs. 2.00; P < 0.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points. CONCLUSION These data suggest that typical atrial flutter constitutes a manifestation of previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and chronic in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.
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Affiliation(s)
- Leon Iden
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
| | - Rolf Weinert
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
| | - Susann Groschke
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
| | - Ralph Toelg
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
| | - Martin Borlich
- Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany
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Hemetsberger R, Toelg R, Mankerious N, Allali A, Traboulsi H, Sulimov DS, El-Mawardy M, Byrne RA, Robinson DR, Kastrati A, Abdel-Wahab M, Richardt G. Impact of calcified lesion complexity on the success of percutaneous coronary intervention with upfront high-speed rotational atherectomy or modified balloons - A subgroup-analysis from the randomized PREPARE-CALC trial. Cardiovasc Revasc Med 2021; 33:26-31. [PMID: 33451925 DOI: 10.1016/j.carrev.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA. METHODS/MATERIALS Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months. RESULTS In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p < 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; pinteraction = 0.001). The need for bail-out RA was higher in patients with type-C lesions (n = 15) as compared with non-type-C lesions (n = 1). Acute lumen gain, LLL, and target lesion revascularization at 9 months were not dependent on lesion complexity and upfront lesion preparation strategy. CONCLUSIONS In patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.
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Affiliation(s)
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Hussain Traboulsi
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | | | - Robert A Byrne
- Cardiovascular Research Institute (CVRI) Dublin, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Derek R Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | | | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Valgimigli M, Cao D, Makkar RR, Bangalore S, Bhatt DL, Angiolillo DJ, Saito S, Ge J, Neumann FJ, Hermiller J, Picon H, Toelg R, Maksoud A, Chehab BM, Wang LJ, Wang J, Mehran R. Design and rationale of the XIENCE short DAPT clinical program: An assessment of the safety of 3-month and 1-month DAPT in patients at high bleeding risk undergoing PCI with an everolimus-eluting stent. Am Heart J 2021; 231:147-156. [PMID: 33031789 DOI: 10.1016/j.ahj.2020.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
Dual antiplatelet therapy (DAPT) is key for the prevention of recurrent ischemic events after percutaneous coronary intervention (PCI); however, it increases the risk of bleeding complications. While new generation drug-eluting stents have been shown superior to bare-metal stents after a short DAPT course, the optimal DAPT duration in patients at high bleeding risk (HBR) remains to be determined. TRIAL DESIGN: The XIENCE Short DAPT program consists of three prospective, single-arm studies (XIENCE 90, XIENCE 28 Global and XIENCE 28 USA) investigating 3- or 1-month DAPT durations in HBR patients undergoing PCI with the XIENCE stent. The XIENCE 90 study is being conducted in the US and enrolled 2047 subjects who discontinued DAPT at 3 months if they were free from myocardial infarction (MI), repeat coronary revascularization, stroke, or stent thrombosis. The XIENCE 28 program includes the USA study, enrolling 642 patients in US and Canada, and the Global study, enrolling 963 patients in Europe and Asia. In XIENCE 28, patients were to discontinue DAPT at 1 month post-PCI if event-free. The primary hypothesis for both XIENCE 90 and XIENCE 28 is that a short DAPT regimen will be non-inferior to a conventional DAPT duration with respect to the composite of all-cause death or MI. Patients enrolled in the prospective multicenter post-market XIENCE V USA study will be used as historical control group in a stratified propensity-adjusted analysis. CONCLUSIONS: The XIENCE Short DAPT Program will provide insights into the safety and efficacy of 2 abbreviated DAPT regimens of 3- and 1-month duration in a large cohort of HBR patients undergoing PCI with the XIENCE stent.
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino, Lugano and Bern University Hospital, Bern, Switzerland
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | | | | | | | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | | | - Bassem M Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, KS
| | | | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY.
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Yeh R, Kereiakes D, Stoler R, Feldman R, Neumann FJ, Boutis L, Tahirkheli N, Toelg R, Othman I, Stein B, Windecker S, Dauerman H, Price M, Underwood P, Allocco D, Meredith I, Kirtane A. TCT CONNECT-381 Predictors of Ischemic and Bleeding Outcomes in High Bleeding Risk Patients Implanted With the SYNERGY Stent—A Post Hoc Analysis From the EVOLVE Short DAPT Study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rheude T, Toelg R, Byrne RA, Allali A, Wiebe J, Sulimov DS, Voll F, Cassese S, Richardt G, Kastrati A, Abdel-Wahab M. Outcomes of rotational atherectomy versus modified balloon angioplasty in severely calcified coronary lesions based on target lesion location: a post hoc analysis of the PREPARE-CALC randomised trial. EUROINTERVENTION 2020; 16:e322-e324. [PMID: 31566573 DOI: 10.4244/eij-d-19-00488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/23/2022]
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Richardt G, Abdelghani M, Allali A, Toelg R, Abdellaoui M, Krackhardt F, Wiseth R, Morice MC, Copt S, Stoll HP, Urban P. Polymer-free drug-coated vs. bare-metal coronary stents in patients undergoing non-cardiac surgery: a subgroup analysis of the LEADERS FREE trial. Clin Res Cardiol 2020; 110:162-171. [PMID: 32440723 DOI: 10.1007/s00392-020-01672-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
AIMS To compare the outcomes of patients undergoing non-cardiac surgery (NCS) after PCI with either a drug-coated stent (DCS) or a bare-metal stent (BMS), followed by 1-month dual antiplatelet therapy and to explore the impact of the timing of NCS. METHODS This is a subgroup analysis of the LEADERS FREE trial. The primary safety end point was a composite of cardiac death, myocardial infarction, or stent thrombosis, and the primary efficacy end point was clinically driven target lesion revascularization (TLR). RESULTS Out of 2432 patients included in the LEADERS FREE trial, 278 (11.4%) underwent NCS within 1 year after PCI. Among NCS patients, the 1-year safety end point was numerically lower with DCS; however, this difference was not significant as compared to BMS (4.7% vs. 10.1%, HR: 0.459 [0.178-1.183], p = 0.099), clinically driven TLR was significantly lower after DCS (2.4% vs. 8.3%, HR: 0.281 [0.079-0.996], p = 0.036), and BARC 3-5 bleeding was similar with DCS vs. BMS (10.2% vs. 7.5%, p = 0.438). In patients treated with BMS, NCS within 3 months after PCI was associated with higher incidence of the safety end point than NCSs performed later: 14.9% vs. 4.4%, HR: 3.586 [1.012-12.709], p = 0.034. The timing of surgery had no impact on patients treated with DCS (4.7% vs. 4.7%, p = 0.947). CONCLUSIONS Among patients undergoing NCS after PCI, DCS-treated patients had a lower probability of clinically driven TLR compared with BMS. However, there was no significant difference in the occurrence of the primary composite safety end point or bleeding complications. Early NCS after BMS-PCI was associated with impaired safety, while the timing of NCS had no such influence after DCS implantation.
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Affiliation(s)
- Gert Richardt
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany.,Cardiology Department, Amesterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cardiology Department, Al-Azhar University, Cairo, Egypt
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany.
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | | | - Rune Wiseth
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Samuel Copt
- Biosensors Clinical Research, Morges, Switzerland
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Abdel-Wahab M, Landt M, Neumann FJ, Massberg S, Frerker C, Kurz T, Kaur J, Toelg R, Sachse S, Jochheim D, Schäfer U, El-Mawardy M, Robinson DR, Richardt G. 5-Year Outcomes After TAVR With Balloon-Expandable Versus Self-Expanding Valves: Results From the CHOICE Randomized Clinical Trial. JACC Cardiovasc Interv 2020; 13:1071-1082. [PMID: 32305398 DOI: 10.1016/j.jcin.2019.12.026] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate clinical and echocardiographic outcome data of the CHOICE (Randomized Comparison of Transcatheter Heart Valves in High Risk Patients with Severe Aortic Stenosis: Medtronic CoreValve Versus Edwards SAPIEN XT) trial at 5 years. BACKGROUND The CHOICE trial was designed to compare device performance of a balloon-expandable (BE) transcatheter heart valve (THV) versus a self-expanding (SE) THV. METHODS The CHOICE trial is an investigator-initiated trial that randomized 241 high-risk patients with severe symptomatic aortic stenosis and an anatomy suitable for treatment with both BE and SE THVs to transfemoral transcatheter aortic valve replacement with either device. The primary endpoint was device success. Patients were followed up to 5 years, with assessment of clinical outcomes, and echocardiographic evaluation of valve function and THV durability. RESULTS After 5 years, there were no statistically significant differences between BE and SE valves in the cumulative incidence of death from any cause (53.4% vs. 47.6%; p = 0.38), death from cardiovascular causes (31.6% vs. 21.5%; p = 0.12), all strokes (17.5% vs. 16.5%; p = 0.73), and repeat hospitalization for heart failure (28.9% vs. 22.5%; p = 0.75). SE patients had larger prosthetic valve area (1.6 ± 0.5 cm2 vs. 1.9 ± 0.5 cm2; p = 0.02) with a lower mean transprosthetic gradient (12.2 ± 8.7 mm Hg vs. 6.9 ± 2.7 mm Hg; p = 0.001) at 5 years. No differences were observed in the rates of paravalvular regurgitation. Clinical valve thrombosis occurred in 7 BE patients (7.3%) and 1 SE patient (0.8%; p = 0.06), and moderate or severe structural valve deterioration in 6 BE patients (6.6%) and no SE patient (0%; p = 0.018). The rate of bioprosthetic valve failure was low and not significantly different between both groups (4.1% vs. 3.4%; p = 0.63). CONCLUSIONS Five-year follow-up of patients in the CHOICE trial revealed clinical outcomes after transfemoral transcatheter aortic valve replacement with early-generation BE and SE valves that were not statistically significantly different, with limited statistical power. Forward flow hemodynamics were significantly better with the SE valve. Moderate or severe structural valve deterioration was uncommon but occurred more frequently with the BE valve. (A Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis: The CHOICE Trial [CHOICE]; NCT01645202).
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Affiliation(s)
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | | | | | - Thomas Kurz
- Cardiology Department, Lübeck University Hospital, Lübeck, Germany
| | | | - Ralph Toelg
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Susanne Sachse
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Ulrich Schäfer
- Cardiology Department, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | | | - Gert Richardt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
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Haude M, Ince H, Kische S, Toelg R, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Barbato E, Garcia-Garcia HM, Waksman R. Sustained Safety and Performance of the Second-Generation Sirolimus-Eluting Absorbable Metal Scaffold: Pooled Outcomes of the BIOSOLVE-II and -III Trials at 3 Years. Cardiovasc Revasc Med 2020; 21:1150-1154. [PMID: 32917533 DOI: 10.1016/j.carrev.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE To avoid long-term effects associated with permanent implants, bioresorbable vascular scaffolds were developed, as they provide transient vessel support and disappear thereafter. The aim of the BIOSOLVE-II and -III studies was to assess the safety and performance of a magnesium-based sirolimus-eluting scaffold; we report the clinical outcomes at 3 years, 2 years after scaffold resorption. METHODS/MATERIALS BIOSOLVE-II and BIOSOLVE-III are international, prospective multi-center studies, including 184 patients with 189 de novo lesions and stable or unstable angina, or documented silent ischemia. Acute myocardial infarction, 3-vessel coronary artery disease, and heavily calcified lesions were excluded. Antiplatelet therapy was recommended for 6 months. RESULTS Patients were 65.5 ± 10.8 years old, and lesions were 12.1 ± 4.5 mm long and located in vessels with a diameter of 2.7 ± 0.4 mm. More than half of the lesions (56.5%) were type B2/C lesions. At 2 years, 92.5% (160/173) of patients were symptom-free and 91.5% (151/165) at 3 years; all the other patients had stable angina. At 3 years, target lesion failure occurred in 11 patients (6.3%), consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSION In a low-risk patient population, treatment with a sirolimus-eluting magnesium bioresorbable scaffold can be considered safe, in particular with no definite or probable scaffold thrombosis. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II and -III are prospective, international, multi-center studies including 184 patients with de novo lesions. At 3 years, target lesion failure was 6.3%, consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany.
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Stefan Verheye
- Interventional Cardiology Middelheim Hospital, Antwerpen, Belgium
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Abdelghani M, Mankerious N, Landt M, Toelg R, Abdel-Wahab M, Richardt G. Transcatheter Aortic Valve Implantation With the Third Generation Balloon-Expandable Bioprosthesis in Patients With Severe Landing Zone Calcium. Am J Cardiol 2020; 125:931-940. [PMID: 31959428 DOI: 10.1016/j.amjcard.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023]
Abstract
Device success of earlier generation balloon-expandable transcatheter heart valves (BE-THV) is lower in patients with severe landing zone calcium (LZC). We sought to explore the impact of LZC on the outcome of transcatheter aortic valve implantation (TAVI) with the next generation Edwards Sapien 3 BE-THV. In the present study, severe LZC was defined as severe aortic valve cusp calcium (AVC) and/or left ventricular outflow tract calcium (LVOTC) on computed tomography. Patients who underwent TAVI for pure/predominant aortic regurgitation, bicuspid aortic valve disease, or failed bioprosthetic valve were excluded. Out of 350 patients who underwent TAVI with the Edwards Sapien 3 (age 80.7 ± 6.1, female: 45.1%, Society of Thoracic Surgeons score: 4.9 ± 3.8, transfemoral: 97.4%), 106 (30.3%) had severe LZC; 78 severe AVC (22.3%) and 49 severe LVOTC (14.0%). Severe LZC was associated with lower device success (96.2% vs 100%, p = 0.008) driven by more prosthetic valve regurgitation (PVR, p = 0.008). On multivariable analysis, PVR was associated with severe LVOTC (odds ratio [95% confidence interval] 2.130 [1.092 to 4.158]) but not with severe AVC (1.529 [0.835 to 2.800]). Balloon predilatation (BPreD) was performed in 42.5% of patients with severe LZC (vs 19.3% in nonsevere LZC; p <0.001) and was associated with prolonged procedural time (p = 0.001) and higher irradiation exposure (p = 0.027). Device success (p = 0.311), major procedural complications (p = 0.132), 30-day safety end point (p = 0.815), and PVR (p = 0.684) were not significantly different between patients with severe LZC who underwent BPreD versus direct TAVI. In conclusion, device success of the third generation BE-THV is lower in severe LZC driven by more PVR, especially in patients with severe LVOTC. In those patients, BPreD prolonged the procedure without improving THV performance.
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Mankerious N, Hemetsberger R, Traboulsi H, Toelg R, Abdel-Wahab M, Richardt G, Allali A. Predictors of In-Hospital Adverse Outcomes after Rotational Atherectomy: Impact of the Target Vessel SYNTAX Score. Cardiovasc Revasc Med 2020; 21:754-759. [PMID: 32139281 DOI: 10.1016/j.carrev.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is an established treatment of calcified lesions, but has some inherent procedural hazards. However, predictors of in-hospital adverse outcomes after RA are poorly investigated. OBJECTIVE To explore the predictors of in-hospital adverse outcomes after RA and to introduce the target vessel SYNTAX score (tvSS) as a potential causal variable. METHODS Patients who underwent RA at our center (n = 323) were divided into two groups according to the occurrence of in-hospital adverse outcomes (a composite of residual stenosis ≥30%, persistent slow flow, dissection requiring additional stenting beyond the primary lesion, perforation, burr entrapment, and in-hospital major adverse cardiac events [MACE]). RESULTS In-hospital adverse outcomes were more frequent in patients with severely-tortuous target vessels or lesions >20 mm, while aorto-ostial and bifurcation lesions, as well as chronic total occlusion rates, were equally distributed among patients with and without adverse outcomes. TvSS was 18 [13-24] vs. 12 [8-17] in patients with vs. without in-hospital adverse outcomes (p < 0.001). A tvSS cut-off value of 15 showed 73% sensitivity and 62% specificity for predicting in-hospital adverse outcomes. TvSS emerged as an independent predictor for in-hospital adverse outcomes along with bailout RA and reduced left ventricular ejection fraction (LVEF). However, after one year, the occurrence of in-hospital adverse outcomes was not associated with an increase in the MACE rate (log-rank p = 0.857). CONCLUSION In-hospital adverse outcomes are higher in patients with more complex target vessel anatomies as indicated by a higher tvSS. Bailout RA and reduced LVEF emerged as additional predictors of in-hospital adverse outcomes.
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Affiliation(s)
- Nader Mankerious
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
| | - Rayyan Hemetsberger
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Hussein Traboulsi
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
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Haude M, Ince H, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Eeckhout E, Garcia-Garcia HM, Waksman R. Safety and performance of the second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) in patients with de novo coronary lesions: three-year clinical results and angiographic findings of the BIOSOLVE-II first-in-man trial. EUROINTERVENTION 2020; 15:e1375-e1382. [DOI: 10.4244/eij-d-18-01000] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saito S, Toelg R, Witzenbichler B, Haude M, Masotti M, Salmeron R, Witkowski A, Uematsu M, Takahashi A, Waksman R, Slagboom T. BIOFLOW-IV, a randomised, intercontinental, multicentre study to assess the safety and effectiveness of the Orsiro sirolimus-eluting stent in the treatment of subjects with de novo coronary artery lesions: primary outcome target vessel failure at 12 months. EUROINTERVENTION 2019; 15:e1006-e1013. [DOI: 10.4244/eij-d-18-01214] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Iden L, Groschke S, Weinert R, Toelg R, Richardt G, Borlich M. 1203Typical atrial flutter is a manifestation of previously silent coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0033] [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
Long-term mortality after ablation of typical atrial flutter has been found to be increased two fold in comparison to atrial fibrillation ablations through a period of five years with unclear mechanism.
Methods
We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of atrial flutter was the first manifestation of cardiac disease.
According to clinical standards of our center, the routine recommendation was to evaluate for CAD by invasive angiogram or CT-scan.
We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed.
Results
Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9 years in AFL vs. 63.2 years in AFIB; p=0.15), body-mass-index (BMI; 28.8 vs. 28.5 kg/m2; p=0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; p=0.35), smoking status (22.2% smokers vs. 28.4%; p=0.23) and renal function (GFR >60 ml/min in 96.7% of all patients vs. 95.7%; p=0.76). There were significantly lower values for left-ventricular ejection fraction (52.5% vs. 59.7%; p<0.001), female sex (17.0% vs. 47.5%; p<0.001), hyperlipidemia (37.9% vs. 58.9%; p<0.001) and family history of cardiovascular disease (15.0 vs. 31.9%; p=0.001) in the AFL vs. AFIB cohorts.
CAD with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (p<0.001). CAD with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (p<0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (p<0.001).
After correction for age, LVEF, BMI, CHA2DS2-VASc-Score and it's individual components, smoking status, hyperlipidemia and family history of cardiovascular disease, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB (OR 5.26).
A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; p=0.001), had a higher number of risk factors (3.08 vs. 2.24; p≤0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs 2.00; p<0.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points.
Odds ratios of CAD with AFL vs AFIB
Discussion
This data suggests that typical atrial flutter constitutes a manifestation for previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and stable in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk-stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.
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Affiliation(s)
- L Iden
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - S Groschke
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - R Weinert
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - R Toelg
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - M Borlich
- Heart Center Bad Segeberg, Bad Segeberg, Germany
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Richardt G, Lefevre T, Saito S, Kandzari D, Koolen J, Toelg R. TCT-276 Individual Patient Data Analysis of the BIOFLOW Study Program Comparing Safety and Efficacy of a Bioresorbable Polymer Sirolimus-Eluting Stent to a Durable Polymer Everolimus-Eluting Stent. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Haude M, Ince H, Kische S, Abizaid A, Toelg R, Lemos PA, Van Mieghem N, Verheye S, von Birgelen C, Christiansen E, Neumann FJ, Witzenbichler B, Kaiser C, Eeckhout E, Escaned J, Garcia-Garcia H, Waksman R. TCT-188 Safety and Clinical Performance of the Drug-Eluting Absorbable Metal Scaffold in the Treatment of Subjects With de Novo Lesions in Native Coronary Arteries at 36-Month Follow-Up: BIOSOLVE-II and BIOSOLVE-III. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.247] [Citation(s) in RCA: 3] [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: 11/30/2022]
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Slagboom T, Toelg R, Witzenbichler B, Haude M, Ruiz-Salmeron RJ, Witkowski A, Waksman R, Saito S. TCT-43 A Prospective Randomized Multicenter Study to Assess the Safety and Effectiveness of the Orsiro Sirolimus-Eluting Stent in the Treatment of Subjects With Up to 2 De Novo Coronary Artery Lesions—BIOFLOW IV: 4-Year Clinical Results. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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