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Jolly SS, Lee SF, Mian R, Kedev S, Lavi S, Moreno R, Montalescot G, Hillani A, Henry TD, Asani V, Storey RF, Silvain J, Spratt JCS, d'Entremont MA, Stankovic G, Zafirovska B, Natarajan MK, Sabate M, Shreenivas S, Pinilla-Echeverri N, Sheth T, Altisent OAJ, Ribas N, Skuriat E, Tyrwhitt J, Mehta SR. SYNERGY-Everolimus-Eluting Stent With a Bioabsorbable Polymer in ST-Elevation Myocardial Infarction: CLEAR SYNERGY OASIS-9 Registry. Am J Cardiol 2024; 220:111-117. [PMID: 38447893 DOI: 10.1016/j.amjcard.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 02/17/2024] [Indexed: 03/08/2024]
Abstract
Our objective was to evaluate the clinical effectiveness of the SYNERGY stent (Boston Scientific Corporation, Marlborough, Massachusetts) in patients with ST-elevation myocardial infarction (STEMI). The only drug-eluting stent approved for treatment of STEMI by the Food and Drug Administration is the Taxus stent (Boston Scientific) which is no longer commercially available, so further data are needed. The CLEAR (Colchicine and spironolactone in patients with myocardial infarction) SYNERGY stent registry was embedded into a larger randomized trial of patients with STEMI (n = 7,000), comparing colchicine versus placebo and spironolactone versus placebo. The primary outcome for the SYNERGY stent registry is major adverse cardiac events (MACE) as defined by cardiovascular death, recurrent MI, or unplanned ischemia-driven target vessel revascularization within 12 months. We estimated a MACE rate of 6.3% at 12 months after primary percutaneous coronary intervention for STEMI based on the Thrombectomy vs percutaneous coronary intervention alone in STEMI (TOTAL) trial. Success was defined as upper bound of confidence interval (CI) to be less than the performance goal of 9.45%. Overall, 733 patients were enrolled from 8 countries with a mean age 60 years, 19.4% diabetes mellitus, 41.3% anterior MI, and median door-to-balloon time of 72 minutes. The MACE rate was 4.8% (95% CI 3.2 to 6.3%) at 12 months which met the success criteria against performance goal of 9.45%. The rates of cardiovascular death, recurrent MI, or target vessel revascularization were 2.7%, 1.9%, 1.0%, respectively. The rates of acute definite stent thrombosis were 0.3%, subacute 0.4%, late 0.4%, and cumulative stent thrombosis of 1.1% at 12 months. In conclusion, the SYNERGY stent in STEMI performed well and was successful compared with the performance goal based on previous trials.
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Affiliation(s)
- Sanjit S Jolly
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada.
| | - Shun Fu Lee
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Rajibul Mian
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Sasko Kedev
- Department of Cardiology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Shahar Lavi
- Department of Medicine, Western University, London, Ontario, Canada
| | - Raul Moreno
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | | | - Ali Hillani
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timothy D Henry
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio
| | - Valon Asani
- Department of Cardiology, Clinical Hospital Tetovo, Tetovo, Macedonia
| | - Robert F Storey
- Department of Cardiology, University of Sheffield, Sheffield, United Kingdom
| | - Johanne Silvain
- Department of Cardiology, Sorbonne University, ACTION Group, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - James C S Spratt
- Department of Cardiology, St. George's University of London, London, England
| | - Marc-André d'Entremont
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada; Department of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Zafirovska
- Department of Cardiology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Madhu K Natarajan
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Manel Sabate
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Satya Shreenivas
- Department of Cardiology, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio
| | - Natalia Pinilla-Echeverri
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | | | - Núria Ribas
- Department of Cardiology, Hospital del Mar, Heart Disease Biomedical Research Group 8GRC), IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain
| | - Elizabeth Skuriat
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Jessica Tyrwhitt
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
| | - Shamir R Mehta
- Department of Medicine, Population Health Research Institute McMaster University, Hamilton, Ontario, Canada
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2
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Saada M, Lavi S. Angiography-Derived Index of Microvascular Resistance: A New Frontier in the Management of Patients With Coronary Artery Disease. Can J Cardiol 2024; 40:444-446. [PMID: 38097172 DOI: 10.1016/j.cjca.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Majdi Saada
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
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3
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Bainey KR, Wood DA, Bossard M, Campo G, Cantor WJ, Lavi S, Madan M, Mehran R, Pinilla-Echeverri N, Rao S, Sarma J, Sheth T, Stankovic G, Steg PG, Storey RF, Tanguay JF, Velianou JL, Welsh RC, Mani T, Cairns JA, Mehta SR. Effects of complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease (COMPLETE-AGE). Am Heart J 2024; 267:70-80. [PMID: 37871781 DOI: 10.1016/j.ahj.2023.10.004] [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: 08/14/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND In ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown. METHODS COMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable nonculprit lesions, versus a strategy of culprit-lesion-only PCI. In this prespecified subgroup analysis, treatment effect according to age (≥65 years vs <65 years) was determined for the first coprimary outcome of cardiovascular (CV) death or new myocardial infarction (MI) and the second coprimary outcome of CV death, new MI, or ischemia-driven revascularization (IDR). Median follow-up was 35.8 months (interquartile range [IQR]: 27.6-44.3 months). RESULTS Of 4,041 patients randomized in COMPLETE, 1,613 were aged ≥ 65 years (39.9%). Higher event rates were observed for both coprimary outcomes in patients aged ≥ 65 years comparted with those aged < 65 years (11.2% vs 7.9%, HR 1.49, 95% CI 1.22-1.83; 14.4% vs 11.8%, HR 1.28, 95% CI 1.07-1.52, respectively). Complete revascularization reduced the first coprimary outcome in patients ≥ 65 years (9.7% vs 12.5%, HR 0.77; 95% CI, 0.58-1.04) and < 65 years (6.7% vs 9.1%, HR 0.72; 95% CI, 0.54-0.96)(interaction P = .74). The second coprimary outcome was reduced in those ≥ 65 years (HR 0.56, 95% CI, 0.43-0.74) and < 65 years (HR 0.48, 95% CI, 0.37-0.61 (interaction P = .37). A sensitivity analysis was performed with consistent results demonstrated using a 75-year threshold (albeit attenuated). CONCLUSIONS In patients with STEMI and multivessel CAD, complete revascularization compared with culprit-lesion-only PCI reduced major cardiovascular events regardless of patient age and could be considered as a revascularization strategy in older adults.
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Affiliation(s)
- Kevin R Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - David A Wood
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gianluca Campo
- Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Ferrara, Italy
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shahar Lavi
- Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Mina Madan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Roxana Mehran
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sunil Rao
- NYU Langone Health System, New York, NY
| | - Jaydeep Sarma
- North West Heart Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | - Tej Sheth
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Goran Stankovic
- University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Robert F Storey
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - James L Velianou
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Thenmozhi Mani
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Shamir R Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
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4
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Chow JK, Bagai A, Tan MK, Har BJ, Yip AMC, Paniagua M, Elbarouni B, Bainey KR, Paradis JM, Maranda R, Cantor WJ, Eisenberg MJ, Dery JP, Madan M, Cieza T, Matteau A, Roth S, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh RC, Kim HH, Robinson SD, Daneault B, Chong AY, Le May MR, Ahooja V, Gregoire JC, Nadeau PL, Laksman Z, Heilbron B, Yung D, Minhas K, Bourgeois R, Overgaard CB, Bonakdar H, Logsetty G, Lavoie AJ, De LaRochelliere R, Mansour S, Spindler C, Yan AT, Goodman SG. Antithrombotic therapies in Canadian atrial fibrillation patients with concomitant coronary artery disease: Insights from the CONNECT AF + PCI-II program. J Cardiol 2023; 82:153-161. [PMID: 36931433 DOI: 10.1016/j.jjcc.2023.03.004] [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: 09/16/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Selecting the appropriate antithrombotic regimen for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) or have had medically managed acute coronary syndrome (ACS) remains complex. This multi-centre observational study evaluated patterns of antithrombotic therapies utilized among Canadian patients with AF post-PCI or ACS. METHODS AND RESULTS By retrospective chart audit, 611 non-valvular AF patients [median (interquartile range) age 76 (69-83) years, CHADS2 score 2 (1-3)] who underwent PCI or had medically managed ACS between August 2018 and December 2020 were identified by 68 cardiologists across eight provinces in Canada. Overall, triple antithrombotic therapy [TAT: combined oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT)] was the most common initial antithrombotic strategy, with use in 53.8 % of patients, followed by dual pathway therapy (32.7 % received OAC and a P2Y12 inhibitor, and 4.1 % received OAC and aspirin) and DAPT (9.3 %). Median duration of TAT was 30 (7, 30) days. Compared to the previous CONNECT AF + PCI-I program, there was an increased use of dual pathway therapy relative to TAT over time (P-value <.0001). DOACs (direct oral anticoagulants) represented 90.3 % of all OACs used overall, with apixaban being the most utilized (50.5 %). Proton pump inhibitors were used in 57.0 % of all patients, and 70.1 % of patients on ASA. Planned antithrombotic therapies at 1 year were: 76.2 % OAC monotherapy, 8.3 % OAC + ASA, 7.9 % OAC + P2Y12 inhibitor, 4.3 % DAPT, 1.3 % ASA alone, and <1 % triple therapy. CONCLUSION In accordance with recent Canadian Cardiovascular Society guideline recommendations, we observed an increased use of dual pathway therapy relative to TAT over time in both AF patients post-PCI (elective and emergent) and in those with medically managed ACS. Additionally, DOACs have become the prevailing form of anticoagulation across all antithrombotic regimens. Our findings suggest that Canadian physicians are integrating evidence-based approaches to optimally manage the bleeding and thrombotic risks of AF patients post-PCI and/or ACS.
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Affiliation(s)
| | - Akshay Bagai
- University of Toronto, Toronto, Canada; St Michael's Hospital, Toronto, Canada
| | - Mary K Tan
- Canadian Heart Research Centre, Toronto, Canada
| | - Bryan J Har
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | | | | | - Basem Elbarouni
- St Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | - Kevin R Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jean-Michel Paradis
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec, Canada
| | | | - Warren J Cantor
- University of Toronto, Toronto, Canada; Southlake Regional Health Centre, Newmarket, Canada
| | | | - Jean-Pierre Dery
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec, Canada
| | - Mina Madan
- University of Toronto, Toronto, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tomas Cieza
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec, Canada
| | - Alexis Matteau
- Centre hospitalier de l'université de Montréal (CHUM), Montreal, Canada
| | - Sherryn Roth
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Scarborough Health Network, Toronto, Canada
| | | | | | | | - Ravi Tahiliani
- Central East Regional Cardiac Care Program, Oshawa, Canada
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Hahn Hoe Kim
- St. Mary's General Hospital, Kitchener-Waterloo, Canada
| | - Simon D Robinson
- Royal Jubilee Hospital, University of British Columbia, Victoria, Canada
| | - Benoit Daneault
- Centre hospitalier Universitaire de Sherbrooke, Sherbrooke University, Sherbrooke, Canada
| | | | | | | | | | | | | | - Brett Heilbron
- University of British Columbia, Vancouver, Canada; St. Paul's Hospital, Vancouver, Canada
| | - Derek Yung
- Scarborough Health Network, Toronto, Canada
| | - Kunal Minhas
- St Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | - Ronald Bourgeois
- Moncton Hospital, Dalhousie University Faculty of Medicine, Moncton, Canada
| | | | - Hamid Bonakdar
- St Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | | | - Andrea J Lavoie
- Regina General Hospital - Prairie Vascular Research Network, Regina, Canada
| | - Robert De LaRochelliere
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec, Canada
| | - Samer Mansour
- Centre hospitalier de l'université de Montréal (CHUM), Montreal, Canada
| | | | - Andrew T Yan
- University of Toronto, Toronto, Canada; St Michael's Hospital, Toronto, Canada.
| | - Shaun G Goodman
- University of Toronto, Toronto, Canada; St Michael's Hospital, Toronto, Canada; Canadian Heart Research Centre, Toronto, Canada.
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5
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d'Entremont MA, Alazzoni A, Dzavik V, Sharma V, Overgaard CB, Lemaire-Paquette S, Lamelas P, Cairns JA, Mehta SR, Natarajan MK, Sheth TN, Schwalm JD, Rao SV, Stankovic G, Kedev S, Moreno R, Cantor WJ, Lavi S, Bertrand OF, Nguyen M, Couture ÉL, Jolly SS. No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial. EUROINTERVENTION 2023:EIJ-D-23-00112. [PMID: 37382909 PMCID: PMC10397677 DOI: 10.4244/eij-d-23-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND The optimal strategy to prevent no-reflow in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is unknown. AIMS We aimed to examine the effect of thrombectomy on the outcome of no-reflow in key subgroups and the adverse clinical outcomes associated with no-reflow. METHODS We performed a post hoc analysis of the TOTAL Trial, a randomised trial of 10,732 patients comparing thrombectomy versus PCI alone. This analysis utilised the angiographic data of 1,800 randomly selected patients. RESULTS No-reflow was diagnosed in 196 of 1,800 eligible patients (10.9%). No-reflow occurred in 95/891 (10.7%) patients randomised to thrombectomy compared with 101/909 (11.1%) in the PCI-alone arm (odds ratio [OR] 0.95, 95% confidence interval [CI]: 0.71-1.28; p-value=0.76). In the subgroup of patients who underwent direct stenting, those randomised to thrombectomy compared with PCI alone experienced less no-reflow (19/371 [5.1%] vs 21/216 [9.7%], OR 0.50, 95% CI: 0.26-0.96). In patients who did not undergo direct stenting, there was no difference between the groups (64/504 [12.7%] vs 75/686 [10.9%)], OR 1.18, 95% CI: 0.82-1.69; interaction p-value=0.02). No-reflow patients had a significantly increased risk of experiencing the primary composite outcome (cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA Class IV heart failure) at 1 year (adjusted hazard ratio 1.70, 95% CI: 1.13-2.56; p-value=0.01). CONCLUSIONS In patients with STEMI treated by PCI, thrombectomy did not reduce no-reflow in all patients but may be synergistic with direct stenting. No-reflow is associated with increased adverse clinical outcomes.
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Affiliation(s)
- Marc-André d'Entremont
- Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Vinoda Sharma
- Birmingham City Hospital, University of Birmingham, Birmingham, UK
| | | | | | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - John A Cairns
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Shamir R Mehta
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tej N Sheth
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - John-David Schwalm
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sunil V Rao
- New York University Langone Health, New York, NY, USA
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Sasko Kedev
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | | | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, ON, Canada
| | | | - Michel Nguyen
- Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
| | - Étienne L Couture
- Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
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6
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Mehta SR, Wang J, Wood DA, Spertus JA, Cohen DJ, Mehran R, Storey RF, Steg PG, Pinilla-Echeverri N, Sheth T, Bainey KR, Bangalore S, Cantor WJ, Faxon DP, Feldman LJ, Jolly SS, Kunadian V, Lavi S, Lopez-Sendon J, Madan M, Moreno R, Rao SV, Rodés-Cabau J, Stanković G, Bangdiwala SI, Cairns JA. Complete Revascularization vs Culprit Lesion-Only Percutaneous Coronary Intervention for Angina-Related Quality of Life in Patients With ST-Segment Elevation Myocardial Infarction: Results From the COMPLETE Randomized Clinical Trial. JAMA Cardiol 2022; 7:1091-1099. [PMID: 36129696 PMCID: PMC9494273 DOI: 10.1001/jamacardio.2022.3032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/25/2022] [Indexed: 01/09/2023]
Abstract
Importance In patients with multivessel coronary artery disease (CAD) presenting with ST-segment elevation myocardial infarction (STEMI), complete revascularization reduces major cardiovascular events compared with culprit lesion-only percutaneous coronary intervention (PCI). Whether complete revascularization also improves angina-related health status is unknown. Objective To determine whether complete revascularization improves angina status in patients with STEMI and multivessel CAD. Design, Setting, and Participants This secondary analysis of a randomized, multinational, open label trial of patient-reported outcomes took place in 140 primary PCI centers in 31 countries. Patients presenting with STEMI and multivessel CAD were randomized between February 1, 2013, and March 6, 2017. Analysis took place between July 2021 and December 2021. Interventions Following PCI of the culprit lesion, patients with STEMI and multivessel CAD were randomized to receive either complete revascularization with additional PCI of angiographically significant nonculprit lesions or to no further revascularization. Main Outcomes and Measures Seattle Angina Questionnaire Angina Frequency (SAQ-AF) score (range, 0 [daily angina] to 100 [no angina]) and the proportion of angina-free individuals by study end. Results Of 4041 patients, 2016 were randomized to complete revascularization and 2025 to culprit lesion-only PCI. The mean (SD) age of patients was 62 (10.7) years, and 3225 (80%) were male. The mean (SD) SAQ-AF score increased from 87.1 (17.8) points at baseline to 97.1 (9.7) points at a median follow-up of 3 years in the complete revascularization group (score change, 9.9 [95% CI, 9.0-10.8]; P < .001) compared with an increase of 87.2 (18.4) to 96.3 (10.9) points (score change, 8.9 [95% CI, 8.0-9.8]; P < .001) in the culprit lesion-only group (between-group difference, 0.97 points [95% CI, 0.27-1.67]; P = .006). Overall, 1457 patients (87.5%) were free of angina (SAQ-AF score, 100) in the complete revascularization group compared with 1376 patients (84.3%) in the culprit lesion-only group (absolute difference, 3.2% [95% CI, 0.7%-5.7%]; P = .01). This benefit was observed mainly in patients with nonculprit lesion stenosis severity of 80% or more (absolute difference, 4.7%; interaction P = .02). Conclusions and Relevance In patients with STEMI and multivessel CAD, complete revascularization resulted in a slightly greater proportion of patients being angina-free compared with a culprit lesion-only strategy. This modest incremental improvement in health status is in addition to the established benefit of complete revascularization in reducing cardiovascular events.
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Affiliation(s)
- Shamir R. Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David A. Wood
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri–Kansas City, Kansas City
| | - David J. Cohen
- Cardiovascular Research Foundation, New York, New York
- St Francis Hospital, Roslyn, New York
| | - Roxana Mehran
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Philippe Gabriel Steg
- Université Paris Cité, INSERM U-1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France and FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tej Sheth
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kevin R. Bainey
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | | | - Warren J. Cantor
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P. Faxon
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laurent J. Feldman
- Université Paris Cité, INSERM U-1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France and FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Sanjit S. Jolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Shahar Lavi
- Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Jose Lopez-Sendon
- Hospital Universitario La Paz, UAM, IdiPaz Research Institute, Madrid, Spain
| | - Mina Madan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Raul Moreno
- Hospital Universitario La Paz, UAM, IdiPaz Research Institute, Madrid, Spain
| | | | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Quebec, Canada
| | - Goran Stanković
- Serbia to Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Shrikant I. Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John A. Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
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Cantor WJ, Tan M, Berwanger O, Lavi S, White HD, Nicolau JC, Dehghani P, Tajer CD, Lopes RD, Moia DDF, Nicholls SJ, Parkhomenko A, Averkov O, Brass N, Lutchmedial S, Malaga G, Damiani LP, Piegas LS, Granger CB, Goodman SG. Morphine and clinical outcomes in patients with ST segment elevation myocardial infarction treated with fibrinolytic and antiplatelet therapy: Insights from the TREAT trial. Am Heart J 2022; 251:1-12. [PMID: 35533724 DOI: 10.1016/j.ahj.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Morphine is commonly used to relieve pain, anxiety and dyspnea in STEMI but it lowers blood pressure and delays the activity of oral antiplatelet agents. The impact of morphine on clinical outcomes remains unknown. This analysis was performed to determine if morphine use was associated with increased risk of adverse clinical events among STEMI patients treated with fibrinolytic therapy and clopidogrel or ticagrelor. METHODS In the Ticagrelor in Patients with ST Elevation Myocardial Infarction Treated with Pharmacological Thrombolysis (TREAT) study, 3799 STEMI patients treated with fibrinolysis were randomized to receive clopidogrel or ticagrelor. Morphine use was left to the discretion of the treating physicians. In this pre-specified analysis, we evaluated clinical outcomes based on the use and timing of morphine administration. Outcomes were stratified by randomized treatment group. Multivariable analysis was performed using Inverse Probability Treatment Weighting (IPTW) weighting. RESULTS Morphine was used in 53% of patients. After adjustment using IPTW weighting, morphine use was associated with higher hazard of reinfarction at 7 days (HR 4.9, P = .0006) and 30 days (HR 1.7, P = .04), and lower hazard of major bleeding (HR 0.37, P = .006). There was no significant difference in mortality at any time point. CONCLUSIONS Among patients with STEMI treated with fibrinolytic therapy, morphine use was associated with a higher risk of early reinfarction and a lower risk of major bleeding but no difference in mortality. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02298088.
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Affiliation(s)
- Warren J Cantor
- Department of Medicine, Southlake Regional Health Centre, University of Toronto, 581 Davis Drive, Newmarket, Toronto, Ontario L3Y 2P6, Canada.
| | - Mary Tan
- Department of Medicine, Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Otavio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Shahar Lavi
- Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Harvey D White
- Department of Medicine, Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Payam Dehghani
- Department of Medicine, Prairie Vascular Research Network and Saskatchewan Health Authority, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Carlos D Tajer
- Department of Medicine, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
| | - Renato D Lopes
- Department of Medicine, Duke Clinical Research Institute, Durham, NC, United States; Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Diogo D F Moia
- Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil
| | - Stephen J Nicholls
- Department of Medicine, Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Alexander Parkhomenko
- Department of Medicine, Emergency Cardiology Department, Institute of Cardiology, Kiev, Ukraine
| | - Oleg Averkov
- Department of Medicine, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Neil Brass
- Department of Medicine, CK Hui Heart Centre, Edmonton, Alberta, Canada
| | - Sohrab Lutchmedial
- Department of Medicine, New Brunswick Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Germán Malaga
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lucas P Damiani
- Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil
| | | | | | - Shaun G Goodman
- Department of Medicine, Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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8
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Alkhalil M, Kuzemczak M, Zhao R, Kavvouras C, Cantor WJ, Overgaard CB, Lavi S, Sharma V, Chowdhary S, Stanković G, Kedev S, Bernat I, Bhindi R, Sheth T, Niemela K, Jolly SS, Džavík V. Prognostic Role of Residual Thrombus Burden Following Thrombectomy: Insights From the TOTAL Trial. Circ Cardiovasc Interv 2022; 15:e011336. [PMID: 35580203 DOI: 10.1161/circinterventions.121.011336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether more effective forms of thrombus removal than current aspiration catheters would lead to improved outcomes. We sought to evaluate the prognostic role of residual thrombus burden (rTB), after manual thrombectomy, in patients undergoing primary percutaneous coronary intervention with routine manual thrombectomy in the TOTAL trial (Thrombectomy Versus PCI Alone). METHODS This is a single-arm analysis of patients from the TOTAL trial who underwent routine manual aspiration thrombectomy. The rTB was quantified by an angiographic core laboratory using the Thrombolysis in Myocardial Infarction criteria and validated using existing optical coherent tomography data. Large rTB was defined as grade ≥3. The primary outcome was death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening heart failure within 180 days. RESULTS Of 5033 patients randomized to routine thrombectomy, 2869 patients had quantifiable rTB (1014 [35%] had large rTB). Patients with large rTB were more likely to have hypertension, previous percutaneous coronary intervention, myocardial infarction, or Killip class III on presentation but less likely to have Killip class I. The primary outcome occurred more frequently in patients with large rTB, even after adjustment for known risk predictors (8.6% versus 4.6%; adjusted hazard ratio, 1.83 [95% CI, 1.34-2.48]). These patients also had a higher risk of cardiovascular death (adjusted hazard ratio, 1.83 [95% CI, 1.13-2.95]), cardiogenic shock (adjusted hazard ratio, 2.02 [95% CI, 1.08-3.76]), and heart failure (adjusted hazard ratio, 1.74 [95% CI, 1.02-2.96]) but not myocardial infarction or stroke. CONCLUSIONS Large rTB is a common finding in primary percutaneous coronary intervention and is associated with increased risk of adverse cardiovascular outcomes, including cardiovascular death. Future technologies offering better thrombus removal than current devices may decrease or even eliminate the risk associated with rTB. This, potentially, can turn into a strategic option to be studied in clinical trials. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01149044.
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Affiliation(s)
- Mohammad Alkhalil
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.).,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (M.A.).,Translational and Clinical Research Institute, Newcastle University, United Kingdom (M.A.)
| | - Michał Kuzemczak
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.).,Division of Emergency Medicine, Poznan University of Medical Sciences, Poland (M.K.).,Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (M.K.)
| | - Robin Zhao
- Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.)
| | - Charalampos Kavvouras
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.)
| | - Warren J Cantor
- Division of Cardiology, University of Toronto and Southlake Regional Health Centre, Canada (W.J.C., C.B.O.)
| | - Christopher B Overgaard
- Division of Cardiology, University of Toronto and Southlake Regional Health Centre, Canada (W.J.C., C.B.O.)
| | - Shahar Lavi
- London Health Sciences Centre, Canada (S.L.)
| | - Vinoda Sharma
- Cardiology Department, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (V.S.)
| | - Saqib Chowdhary
- Cardiology Department, Wythenshawe Hospital, Manchester, United Kingdom (S.C.)
| | - Goran Stanković
- Department of Cardiology, University of Belgrade, Serbia (G.S.)
| | - Saško Kedev
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia (S.K.)
| | - Ivo Bernat
- University Hospital and Faculty of Medicine Pilsen, Czech Republic (I.B.)
| | - Ravinay Bhindi
- Royal North Shore Hospital, University of Sydney, Australia (R.B.)
| | - Tej Sheth
- Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.)
| | | | - Sanjit S Jolly
- Population Health Research Institute, McMaster University, Hamilton, Canada (R.Z., T.S., S.S.J.)
| | - Vladimír Džavík
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Canada (M.A., M.K., C.K., V.D.)
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9
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Bagur R, Ybarra LF, Israeli Z, Solomonica A, Taleb H, Savvoulidis P, Sanjoy SS, Lavi S. Postprocedural Radial Artery Compression Time In Chronic AnticoaguLated patients using StatSeal: The PRACTICAL-SEAL study. Int J Cardiol 2022; 346:14-17. [PMID: 34774642 DOI: 10.1016/j.ijcard.2021.11.011] [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: 09/08/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients on uniterrupted chronic oral anticoagulation (OAC) therapy are at high-risk of bleeding during cardiac catheterization. We aimed to investigate the safety and efficacy of the StatSeal® disc for adjunct hemostasis in patients undergoing transradial coronary angiography under uninterrupted OAC therapy. METHODS Patients who underwent transradial cardiac catheterization without interrupted OAC therapy were included in this study. RESULTS Among 180 patients, 85 (47.2%) patients were on warfarin and 95 (52.8%) patients on novel oral anticoagulants (NOACs). Patients on NOACs were older (72.9 ± 9.6 versus 69.7 ± 10.8 years, P < 0.001) and had more atrial fibrillation/flutter (94.7% versus 62.4%, P < 0.001), whereas patients on Warfarin were more often women (43.5% versus 26.3%, P = 0.02) and had mechanical heart valves (27.1% versus 0%, P < 0.001). Intravenous unfractioned heparin (UFH) was administered in 96.5% of patients on warfarin (3799 ± 1342 units) and 93.7% patients on NOACs (4028 ± 1362 units), P = 0.27. There were no differences in terms of type and sheath size and the need for ad hoc coronary intervention. Time-to-first release of the hemostatic wristband was 56.2 ± 12.6 min and complete hemostasis was achieved in 71.1 ± 13.0 min, with shorter times among patients on NOACs (54.1 ± 11.7 and 58.5 ± 13.2 min, 68.9 ± 11.7 versus 73.6 ± 14.0 min, P = 0.02, for both). There were no significant differences in terms of bleeding. There was no radial artery occlusion among 112 participants who underwent color Doppler ultrasound. CONCLUSION The present study shows that in patients undergoing transradial coronary angiogram under contemporary uninterrupted OAC therapy and periprocedural administration of UFH, the use of StatSeal® disc for adjunctive hemostasis was associated with short times to complete hemostasis.
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Affiliation(s)
- Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada.
| | - Luiz F Ybarra
- London Health Sciences Centre, London, Ontario, Canada
| | - Zeev Israeli
- Division of Cardiology, Ziv Medical Center, Safed, Israel
| | - Amir Solomonica
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Hussein Taleb
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Shubrandu S Sanjoy
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
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10
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Arbel Y, Patel AD, Goodman SG, Tan MK, Suskin N, McKelvie RS, Mathew AL, Ahmed F, Lutchmedial S, Dehghani P, Lavoie AJ, Huynh T, Lavi S, Khan R, Yan AT, Fordyce CB, Heffernan M, Jedrzkiewicz S, Madan M, Ahmed S, Barry C, Dery JP, Bagai A. Provision of a DAPT Score to Cardiologists and Extension of Dual Antiplatelet Therapy Beyond 1 Year After ACS: Randomized Substudy of the Prospective Canadian ACS Reflective II Study. CJC Open 2021; 3:1463-1470. [PMID: 34993458 PMCID: PMC8712544 DOI: 10.1016/j.cjco.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Extension of dual antiplatelet therapy (DAPT) beyond 1 year after acute coronary syndrome is associated with a reduction in ischemic events but also increased bleeding. The DAPT score identifies individuals likely to derive overall benefit or harm from DAPT extension. We sought to evaluate the impact of providing the DAPT score to treating physicians on the decision to extend DAPT beyond 1 year after non–ST-segment elevation myocardial infarction. Methods Moderate to high-risk non–ST-segment elevation myocardial infarction patients were enrolled from July 2016 to May 2018 in 13 Canadian hospitals by 52 cardiologists. Participating cardiologists were randomly assigned 1:1 to receive their individual patients’ DAPT scores before the 1-year follow-up visit vs not receiving their patients’ DAPT scores. Rates of DAPT extension were compared among the randomized groups. Results At 1 year, 370 of the 585 (63.2%) patients discharged on DAPT were receiving DAPT. Among patients on DAPT at 1 year, the median (25th, 75th percentile) DAPT score was 2 (1,3). DAPT was extended beyond 1 year in 36.2% randomly assigned to provision of DAPT score vs 35.7% in the control group (P = 0.93). In the subgroup of patients with DAPT score ≥ 2, DAPT extension was 49.5% in the DAPT score provision arm vs 40.4% in the control arm (P = 0.22); among patients with DAPT score < 2, DAPT termination was 78.6% in the DAPT score provision arm vs 70.6% in the control arm (P = 0.26) (P value for interaction = 0.1). Conclusions In this exploratory randomized trial, provision of the DAPT score to treating physicians had no impact on the duration of DAPT treatment beyond 1 year.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashish D. Patel
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Shaun G. Goodman
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Mary K. Tan
- Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Neville Suskin
- St Joseph’s Health Care London, Western University, London, Ontario, Canada
| | - Robert S. McKelvie
- St Joseph’s Health Care London, Western University, London, Ontario, Canada
| | - Andrew L. Mathew
- St Joseph’s Health Care London, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Firas Ahmed
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Payam Dehghani
- Saskatchewan Health Authority, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Andrea J. Lavoie
- Saskatchewan Health Authority, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Thao Huynh
- McGill University Health Centre, Montreal, Québec, Canada
| | - Shahar Lavi
- University Hospital, Western University, London, Ontario, Canada
| | - Razi Khan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Andrew T. Yan
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B. Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shaheeda Ahmed
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Colin Barry
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Jean-Pierre Dery
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
| | - Akshay Bagai
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Akshay Bagai, Terrence Donnelly Heart Centre, St Michael’s Hospital, 30 Bond St, Toronto, Ontario Canada. Tel.: +1-416-864-5783; fax: +1-416-864-5989.
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11
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Garg A, Rao-Melacini P, Quinn R, Ainsworth C, Belley-Cote E, Cairns J, Cantor W, Dzavik V, Gomez RM, Kedev S, Lavi S, Stankovic G, Jolly S. TOTAL risk score for predicting safe very early discharge in patients with ST-elevation myocardial infarction (STEMI). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Previously validated risk scores for identifying low-risk patients after ST-segment elevation myocardial infarction (STEMI) have led to acceptance of the safety and feasibility of discharge after 48–72 hours of hospitalization, reducing hospital length of stay and costs. With ongoing improvements in outcomes, it may be possible to select patients who are safe to discharge very early (24–48 hours) but this has never been evaluated.
Purpose
We sought to develop and validate a novel risk score for identifying low-risk patients suitable for very early discharge (≤48 hours of hospitalization) post-STEMI.
Methods
We derived a novel risk score using data from patients enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL). The TOTAL database was randomly divided into a derivation cohort with 2/3 of the composite events and non-events and remaining 1/3 as the internal validation cohort. Using the derivation cohort, we identified risk factors for cardiovascular death (CV) or non-fatal cardiac arrest by performing a univariate and multivariable stepwise regression analysis of baseline clinical and angiographic characteristics. Each co-variate was assigned an integer score based on regression coefficients and the novel TOTAL risk score was developed by adding points from each risk factor profile. We externally validated the TOTAL score using data from the Radial versus Femoral Access for Coronary Intervention (RIVAL) trial.
Results
The TOTAL derivation cohort included 6331 participants with 287 events (CV death/cardiac arrest). Twelve independent risk-factors associated with risk of CV death and non-fatal cardiac arrest at 1 year were selected and weighted for the TOTAL risk score (Table 1). In the TOTAL validation cohort (n=3166), patients with a TOTAL score of 0–4 points (n=779 (24.6%)) were categorized as very low risk with only a 0.1% risk of CV death/cardiac arrest observed within 24 hours of hospitalization, and no further events observed between 24 hours and 30 days post-STEMI. In the RIVAL validation dataset (n=1451), patients with a TOTAL score of 0–4 points (n=737 (50.7%)) had a 0.3% risk of CV death/cardiac arrest within 24 hours, with no further events observed between 24 hours and 72 hours of hospitalization.
Conclusion
The TOTAL risk score identified a very low risk subset of patients for whom early discharge, 24–48 hours post-STEMI, is likely safe. These findings have the potential to change practice and support early discharge after STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Garg
- McMaster University, Hamilton, Canada
| | | | - R Quinn
- McMaster University, Hamilton, Canada
| | | | - E Belley-Cote
- Population Health Research Institute, Hamilton, Canada
| | - J Cairns
- University of British Columbia, Vancouver, Canada
| | - W Cantor
- Southlake Regional Health Centre, Newmarket, Canada
| | - V Dzavik
- Peter Munk Cardiac Centre, Toronto, Canada
| | | | - S Kedev
- University of St Cyril and Methodius, Skopje, North Macedonia
| | - S Lavi
- Western University, London, Canada
| | - G Stankovic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - S Jolly
- Population Health Research Institute, Hamilton, Canada
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Graham C, Tan M, Chew D, Gale C, Fox K, Bagai A, Henderson M, Quraishi A, Dery J, Cheema A, Fisher H, Brieger D, Lutchmedial S, Lavi S, Wong B, Cieza T, Mehta S, Goodman S, Yan A. USE AND OUTCOME OF DUAL ANTIPLATELET THERAPY FOR ACUTE CORONARY SYNDROME IN PATIENTS WITH CHRONIC KIDNEY DISEASE: INSIGHTS FROM THE CANADIAN OBSERVATIONAL ANTIPLATELET STUDY (COAPT), A MULTICENTRE PROSPECTIVE COHORT STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Goodman S, Bagai A, Tan M, Andrade J, Spindler C, Malek-Marzban P, Har B, Yip A, Paniagua M, Elbarouni B, Bainey K, Paradis J, Maranda R, Cantor W, Doucet M, Khan R, Eisenberg M, Dery J, Schwalm J, Madan M, Lam A, Hameed A, Noronha L, Cieza T, Matteau A, Roth S, So D, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh R, Kim H, Robinson S, Daneault B, Chong A, Le May M, Ahooja V, Gregoire J, Nadeau P, Laksman Z, Heilbron B, Bonakdar H, Yung D, Yan A. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Dehghani P, Cantor WJ, Wang J, Wood DA, Storey RF, Mehran R, Bainey KR, Welsh RC, Rodés-Cabau J, Rao S, Lavi S, Velianou JL, Natarajan MK, Ziakas A, Guiducci V, Fernández-Avilés F, Cairns JA, Mehta SR. Complete Revascularization in Patients Undergoing a Pharmacoinvasive Strategy for ST-Segment-Elevation Myocardial Infarction: Insights From the COMPLETE Trial. Circ Cardiovasc Interv 2021; 14:e010458. [PMID: 34320839 DOI: 10.1161/circinterventions.120.010458] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada (P.D.)
| | - Warren J Cantor
- Toronto Southlake Regional Health Centre, University of Toronto, Ontario, Canada (W.J.C.)
| | - Jia Wang
- Hamilton Health Sciences, McMaster University, Ontario, Canada (J.W., J.L.V., M.K.N., S.R.M.)
- Population Health Research Institute, Hamilton, Ontario, Canada (J.W., M.K.N., S.R.M.)
| | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Canada (D.A.W., J.A.C.)
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom (R.F.S.)
| | - Roxana Mehran
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Kevin R Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., R.C.W.)
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., R.C.W.)
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (J.R.-C.)
| | - Sunil Rao
- Duke University Medical Center, Durham, NC (S.R.)
| | - Shahar Lavi
- London Health Sciences Centre, University of Western Ontario, Canada (S.L.)
| | - James L Velianou
- Hamilton Health Sciences, McMaster University, Ontario, Canada (J.W., J.L.V., M.K.N., S.R.M.)
| | - Madhu K Natarajan
- Hamilton Health Sciences, McMaster University, Ontario, Canada (J.W., J.L.V., M.K.N., S.R.M.)
- Population Health Research Institute, Hamilton, Ontario, Canada (J.W., M.K.N., S.R.M.)
| | - Antonios Ziakas
- AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (A.Z.)
| | | | | | - John A Cairns
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Canada (D.A.W., J.A.C.)
| | - Shamir R Mehta
- Hamilton Health Sciences, McMaster University, Ontario, Canada (J.W., J.L.V., M.K.N., S.R.M.)
- Population Health Research Institute, Hamilton, Ontario, Canada (J.W., M.K.N., S.R.M.)
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15
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Bakar SN, Hayman S, McCarty D, Thain AP, McLellan A, Wagner C, Lavi S. Invasive Assessment of Microvascular Resistance in Hypertrophic Cardiomyopathy With Echocardiographic Correlates. Heart Lung Circ 2021; 31:194-198. [PMID: 34332889 DOI: 10.1016/j.hlc.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/20/2020] [Revised: 04/18/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is often associated with ischaemia despite lack of focal epicardial coronary stenosis. Our aim was to assess invasive coronary microvascular circulation and correlate findings with echocardiography. METHODS We prospectively enrolled patients with HCM and controls who were referred for diagnostic coronary angiography. A pressure-temperature sensor coronary guidewire was used with intracoronary injections of room-temperature saline to measure mean coronary transit time during rest and hyperaemia induced with intravenous adenosine. The index of microvascular resistance (IMR) was calculated. Left ventricular mass was calculated during echocardiographic studies. RESULTS Patients with HCM (n=12) and controls (n=7), had similar demographics. Left ventricular ejection fraction was higher in HCM (76.7%±11.0% vs 55.0%±15.9%, p=0.003). IMR was non-significantly higher in HCM (21.7±10.2 vs 15.3±4.8, p=0.16). Only patients with HCM had abnormal IMR (>25). Coronary flow reserve was non-significantly higher in HCM (2.7±1.6 vs 2.1±1.2, p=0.34). IMR correlated with left ventricular mass in hypertrophic cardiomyopathy subjects (Pearson r=0.68, p=0.02). CONCLUSIONS Microvascular dysfunction as assessed by IMR may be abnormal in HCM and is correlated with left ventricular mass.
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Affiliation(s)
- Shahrukh N Bakar
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Samual Hayman
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - David McCarty
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Andrew P Thain
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Andrew McLellan
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Cassandra Wagner
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Shahar Lavi
- Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada.
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16
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Patel A, Goodman SG, Tan M, Suskin N, McKelvie R, Mathew AL, Lutchmedial S, Dehghani P, Lavoie AJ, Huynh T, Lavi S, Philipp R, Khan R, Yan AT, Radhakrishnan S, Sedlak T, Brunner N, Kim HH, Cieza T, Kassam S, Fordyce CB, Heffernan M, Jedrzkiewicz S, Madan M, Ahmed S, Barry C, Dery JP, Bagai A. Contemporary use of guideline-based higher potency P2Y12 receptor inhibitor therapy in patients with moderate-to-high risk non-ST-segment elevation myocardial infarction: Results from the Canadian ACS reflective II cross-sectional study. Clin Cardiol 2021; 44:839-847. [PMID: 33982795 PMCID: PMC8207978 DOI: 10.1002/clc.23618] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/11/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background After myocardial infarction, guidelines recommend higher‐potency P2Y12 receptor inhibitors, namely ticagrelor and prasugrel, over clopidogrel. Hypothesis We aimed to determine the contemporary use of higher‐potency antiplatelet therapy in Canadian patients with non‐ST‐elevation myocardial infarction (NSTEMI). Methods A total of 684 moderate‐to‐high risk NSTEMI patients were enrolled in the prospective Canadian ACS Reflective II registry at 12 Canadian hospitals and three clinics in five provinces between July 2016 and May 2018. Multivariable logistic regression modeling was performed to assess factors independently associated with higher‐potency P2Y12 receptor inhibitor use at discharge. Results At hospital discharge, 78.3% of patients were treated with a P2Y12 receptor inhibitor. Among patients discharged on a P2Y12 receptor inhibitor, use of higher‐potency P2Y12 receptor inhibitor was 61.4%. After adjustment, treatment in‐hospital with PCI (OR 4.48, 95%CI 3.34–6.03, p < .0001) was most strongly associated with higher use of higher‐potency P2Y12 receptor inhibitor, while oral anticoagulant use at discharge (OR 0.03, 95%CI 0.01–0.12, p < .0001), and atrial fibrillation (OR 0.40, 95%CI 0.17–0.98, p = .046) were most strongly associated with lower use of higher‐potency P2Y12 receptor inhibitor. Use of higher‐potency P2Y12 receptor inhibitor varied across provinces (range, 21.6%–78.9%). Discussion In contemporary Canadian practice, approximately 60% of moderate‐to‐high risk NSTEMI patients discharged on a P2Y12 receptor inhibitor are treated with a higher‐potency P2Y12 receptor inhibitor. In addition to factors that increase risk of bleeding, interprovincial differences in practice patterns were associated with use of higher‐potency P2Y12 receptor inhibitor at discharge. Opportunities remain for further optimization of evidence‐based, guideline‐recommended antiplatelet therapy use.
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Affiliation(s)
- Ashish Patel
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada.,Canadian Heart Research Centre, Toronto, Canada
| | - Mary Tan
- Canadian Heart Research Centre, Toronto, Canada
| | - Neville Suskin
- St Joseph's Health Care London, Western University, Lawson Research Institute, London, Canada
| | - Robert McKelvie
- St Joseph's Health Care London, Western University, Lawson Research Institute, London, Canada
| | - Andrew L Mathew
- St Joseph's Health Care London, Western University, Lawson Research Institute, London, Canada.,University Hospital, London Health Sciences Centre, London, Canada
| | | | - Payam Dehghani
- Regina General Hospital - Prairie Vascular Research Network, Regina, Canada
| | - Andrea J Lavoie
- Regina General Hospital - Prairie Vascular Research Network, Regina, Canada
| | - Thao Huynh
- McGill University Health Centre, Montreal, Canada
| | - Shahar Lavi
- University Hospital, London Health Sciences Centre, London, Canada
| | - Roger Philipp
- Royal Columbian Hospital, Keary Medical Centre, New Westminster, Canada
| | - Razi Khan
- Royal Columbian Hospital, Keary Medical Centre, New Westminster, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Sam Radhakrishnan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nathan Brunner
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Hahn Hoe Kim
- St Mary's Regional Cardiac Centre, Kitchener, Canada
| | - Tomas Cieza
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec City, Canada
| | | | | | | | | | - Mina Madan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Shaheeda Ahmed
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Colin Barry
- New Brunswick Heart Centre, Saint John, Canada
| | - Jean-Pierre Dery
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec City, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada
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17
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Moxham R, Džavík V, Cairns J, Natarajan MK, Bainey KR, Akl E, Tsang MB, Lavi S, Cantor WJ, Madan M, Liu YY, Jolly SS. Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial. JAMA Netw Open 2021; 4:e213505. [PMID: 33769510 PMCID: PMC7998077 DOI: 10.1001/jamanetworkopen.2021.3505] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Patients with shorter ischemic times have a greater viable myocardium and may derive greater benefit from thrombus aspiration. OBJECTIVE To study the association of thrombus aspiration with outcomes among patients presenting with ST-segment elevation myocardial infarction (STEMI) based on time. DESIGN, SETTING, AND PARTICIPANTS The TOTAL (Thrombectomy With PCI vs PCI Alone in Patients with STEMI) trial was an international randomized clinical trial of 10 732 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Patients were recruited between August 5, 2010, and July 25, 2014, and were followed up for 1 year. Data analysis was performed from February 22, 2019, to January 5, 2021. INTERVENTIONS Thrombus aspiration vs PCI alone. MAIN OUTCOMES AND MEASURES Post hoc subgroup analyses were performed for total ischemic time and first medical contact (FMC)-to-device time for the primary outcomes (cardiovascular [CV] mortality, myocardial Infarction [MI], cardiogenic shock, and New York Heart Association class IV heart failure) and angiographically determined distal embolization. In addition, a multivariable analysis was performed to assess the association of total ischemic time and FMC-to-device time with CV mortality at 1 year. RESULTS The study randomized 10 732 patients, and 9986 underwent primary PCI and had time data available (7737 men [77.5%]; mean [SD] age, 61.0 [12.0] years). For the randomized comparison of thrombus aspiration, there was a reduction in angiographic distal embolization with thrombus aspiration that was more pronounced in patients with short ischemic times (<2 hours: odds ratio [OR], 0.23 [95% CI, 0.09-0.62]; 2-6 hours: OR, 0.54 [95% CI, 0.39-0.73]; >6 hours: OR, 0.70 [95% CI, 0.33-1.50]; P = .12 for interaction). However, for the primary composite outcome, there was no benefit based on (1) total ischemic time (<2 hours: hazard ratio [HR], 0.77 [95% CI, 0.46-1.28]; 2-6 hours: HR, 1.03 [95% CI, 0.85-1.25]; >6 hours: HR, 0.87 [95% CI, 0.60-1.27]; P = .46 for interaction) or (2) FMC-to-device time (<60 minutes: HR, 1.14 [95% CI, 0.66-1.95]; 60-90 minutes: HR, 0.94 [95% CI, 0.67-1.32]; >90-120 minutes: HR, 1.19 [95% CI, 0.85-1.67]; >120 minutes: HR, 0.89 [95% CI, 0.70-1.14]; P = .54 for interaction). In a multivariable analysis, both total ischemic time (>2 hours: HR, 1.26 [95% CI, 1.00-1.58) and FMC-to-device time (>120 minutes: HR, 1.45 [95% CI, 1.18-1.79]) were independently associated with CV mortality. CONCLUSIONS AND RELEVANCE This analysis suggests that thrombus aspiration does not appear to be associated with an improvement in clinical outcomes regardless of ischemic time. In the current STEMI era, both total ischemic time and FMC-to-device times continue to be important factors associated with mortality. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01149044.
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Affiliation(s)
- Rachel Moxham
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - John Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Madhu K. Natarajan
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Elie Akl
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael B. Tsang
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Warren J. Cantor
- Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yan Yun Liu
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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18
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Haghbayan H, Durocher D, Coomes E, Lavi S. Adenosine diphosphate receptor inhibitor monotherapy with ticagrelor or clopidogrel following percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
In patients undergoing percutaneous coronary intervention (PCI) with implantation of coronary stents, the risk of stent thrombosis is mitigated with antiplatelet therapy. While current clinical practice is to treat patients with dual antiplatelet therapy (DAPT) combining aspirin with an adenosine diphosphate receptor inhibitor (ADPri), prolonged therapy is associated with heightened bleeding risk. Limiting DAPT to a shorter period after PCI, followed by ADPri monotherapy, may be an attractive strategy for optimizing the balance between thrombotic and bleeding risks. While several randomized controlled trials (RCTs) have been published examining this strategy, the optimal duration of abbreviated DAPT run-in and the ideal choice of ADPri remain uncertain.
Methods
We undertook a systematic review and meta-analysis of RCTs assessing abbreviated DAPT followed by ADPri monotherapy post coronary stenting. Our primary outcomes were defined as clinically important bleeding, major adverse cardiovascular events (MACE), and all-cause mortality. We searched Ovid MEDLINE and EMBASE from their inceptions to November 2019 with study selection and data extraction performed in duplicate. We pooled data at one year using random effects models; relative risks (RRs) with 95% confidence intervals (95% CIs) were generated using the inverse variance method. Pre-specified sub-group analyses were undertaken according to duration of DAPT and the primary ADPri employed.
Results
Four trials (n=29084) were eligible for inclusion. Mean age was 65 years and 51.5% of patients were recruited in the context of acute coronary syndrome. Following meta-analysis, the occurrence of clinically significant bleeding events was significantly lower in patients receiving ADPri monotherapy (4 studies; n=29084; RR=0.60; 95% CI, 0.43–0.83; I2=73%; Figure-A), with no significant difference in the rates of all-cause mortality (4 studies; n=29084; RR=0.87; 95% CI, 0.71–1.06; I2=0%; Figure-B) or MACE (4 studies; n=29084; RR=0.90; 95% CI, 0.79–1.03; I2=1%; Figure-C). In subgroup analysis, trends toward lower rates of both all-cause mortality (2 studies; n=23082 participants; RR=0.81; 95% CI, 0.65–1.01; I2=0%; Figure-B) and MACE (2 studies; n=23082 participants; RR=0.90; 95% CI, 0.79–1.03; I2=25%; Figure-C) were seen in the studies employing ticagrelor as opposed to clopidogrel; however, neither analysis reached statistical significance (p-values=0.06 and 0.19, respectively). There was no differential treatment effect based on the duration of abbreviated DAPT prior to ADPri monotherapy in sub-group analysis.
Conclusions
Following PCI in patients with coronary disease, an abbreviated course of DAPT followed by ADPri monotherapy significantly reduces rates of bleeding with no difference in rates of MACE or all-cause mortality. Future studies are required to conclusively determine whether the use of ticagrelor in this setting may also reduce rates of all-cause mortality.
Meta-analysis of included studies
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Haghbayan
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, London, Canada
| | - D.P Durocher
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, London, Canada
| | - E.A Coomes
- University of Toronto, Division of Infectious Diseases, Department of Medicine, Toronto, Canada
| | - S Lavi
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, London, Canada
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19
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Haghbayan H, Durocher D, Coomes E, Lavi S. ADENOSINE DIPHOSPHATE RECEPTOR INHIBITOR MONOTHERAPY WITH TICAGRELOR OR CLOPIDOGREL FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Cantor WJ, Lavi S, Džavík V, Cairns J, Cheema AN, Della Siega A, Moreno R, Stankovic G, Kedev S, Natarajan MK, Levi Y, Yuan F, Jolly SS. Upstream anticoagulation for patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the TOTAL trial. Catheter Cardiovasc Interv 2020; 96:519-525. [PMID: 31613046 DOI: 10.1002/ccd.28540] [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: 01/16/2019] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the relationship between preprocedural anticoagulation use and clinical and angiographic outcomes. BACKGROUND For patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of anticoagulant administration remains uncertain. METHODS Patients enrolled in the TOTAL trial were stratified based on whether or not they had received any parenteral anticoagulant prior to randomization and PCI. Baseline and procedural characteristics were compared. For one-year clinical outcomes, Cox proportional modeling adjusted on a propensity score was used to analyze differences between groups. Angiographic endpoints were analyzed by logistic regression models adjusted for propensity scores. RESULTS In the trial, 10,064 patients were enrolled and underwent PCI. Preprocedural anticoagulation was used in 6,381 patients (63%).The most common anticoagulant was intravenous unfractionated heparin (5,188, 81%). Patients who received preprocedural anticoagulation had higher rates of TIMI-2-3 or TIMI-3 flow and lower grades of thrombus prior to PCI. Pretreatment with anticoagulation was associated with lower use of bailout thrombectomy, GP IIb/IIIa inhibitors, and intra-aortic balloon pump. After adjustment, preprocedural anticoagulation was associated with lower rates of CABG and minor bleeding at 1 year but there were no significant differences in death, stroke, recurrent MI, cardiogenic shock, or congestive heart failure. CONCLUSIONS Preprocedural anticoagulation is associated with improved flow and reduced thrombus in the IRA prior to PCI, less bailout thrombectomy during PCI but no difference in death, recurrent infarction, or heart failure at 1 year.
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Affiliation(s)
- Warren J Cantor
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shahar Lavi
- University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - John Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Goran Stankovic
- Clinical Center of Serbia and Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sasko Kedev
- University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia
| | - Madhu K Natarajan
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Yaniv Levi
- University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Fei Yuan
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S Jolly
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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21
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Pinilla-Echeverri N, Mehta SR, Wang J, Lavi S, Schampaert E, Cantor WJ, Bainey KR, Welsh RC, Kassam S, Mehran R, Storey RF, Nguyen H, Meeks B, Wood DA, Cairns JA, Sheth T. Nonculprit Lesion Plaque Morphology in Patients With ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2020; 13:e008768. [DOI: 10.1161/circinterventions.119.008768] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
Complete revascularization with routine percutaneous coronary intervention of nonculprit lesions after primary percutaneous coronary intervention improves outcomes in ST-segment–elevation myocardial infarction. Whether this benefit is associated with nonculprit lesion vulnerability is unknown.
Methods:
In a prospective substudy of the COMPLETEs trial (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI), we performed optical coherence tomography of at least 2 coronary arteries before nonculprit lesion percutaneous coronary intervention in 93 patients with ST-segment–elevation myocardial infarction and multivessel disease; and the ST-segment–elevation myocardial infarction culprit vessel if there was unstented segment amenable to imaging. Nonculprit lesions were categorized as obstructive (≥70% stenosis by visual angiographic assessment) or nonobstructive, and as thin-cap fibroatheroma (TCFA) or non-TCFA by optical coherence tomography criteria. TCFA was defined as a lesion with mean fibrous cap thickness <65 μm overlying a lipid arc >90°.
Results:
On a patient level, at least one obstructive TCFA was observed in 44/93 (47%) of patients. On a lesion level, there were 58 TCFAs among 150 obstructive nonculprit lesions compared with 74 TCFAs among 275 nonculprit lesions (adjusted TCFA prevalence: 35.4% versus 23.2%,
P
=0.022). Compared with obstructive non-TCFAs, obstructive TCFAs had similar lesion length (23.1 versus 20.8 mm,
P
=0.16) but higher lipid quadrants (55.2 versus 19.2,
P
<0.001), greater mean lipid arc (203.8° versus 84.5°,
P
<0.001), and more macrophages (97.1% versus 54.4%,
P
<0.001) and cholesterol crystals (85.8% versus 44.3%,
P
<0.001). For nonobstructive lesions, TCFA lesions had similar lesion length (16.7 versus 14.6 mm,
P
=0.11), but more lipid quadrants (36.4 versus 13.5,
P
<0.001), and greater mean lipid arc (191.8° versus 84.2°,
P
<0.001) compared with non-TCFA.
Conclusions:
Among patients who underwent optical coherence tomography imaging in the COMPLETE trial, nearly 50% had at least one obstructive nonculprit lesion containing complex vulnerable plaque. Obstructive lesions more commonly harbored vulnerable plaque morphology than nonobstructive lesions. This may help explain the benefit of routine percutaneous coronary intervention of obstructive nonculprit lesions in patients with ST-segment–elevation myocardial infarction and multivessel disease.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01740479s.
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Affiliation(s)
- Natalia Pinilla-Echeverri
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
| | - Shamir R. Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
| | - Jia Wang
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
| | - Shahar Lavi
- London Health Sciences Centre, Western University, ON, Canada (S.L.)
| | - Erick Schampaert
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, QC, Canada (E.S.)
| | - Warren J. Cantor
- Southlake Regional Health Centre, University of Toronto, ON, Canada (W.J.C.)
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada (K.R.B., R.C.W.)
| | - Robert C. Welsh
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada (K.R.B., R.C.W.)
| | - Saleem Kassam
- Scarborough Health Network–Centenary site, ON, Canada (S.K.)
| | - Roxana Mehran
- The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom (R.F.S.)
| | - Helen Nguyen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
| | - Brandi Meeks
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
| | - David A. Wood
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada (D.A.W., J.A.C.)
| | - John A. Cairns
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada (D.A.W., J.A.C.)
| | - Tej Sheth
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.)
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22
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Solomonica A, Wagner C, Lavi S. Endothelial Dysfunction Is Not Associated With Spontaneous Coronary Artery Dissection. Cardiovasc Revasc Med 2020; 21:1539-1541. [PMID: 32473907 DOI: 10.1016/j.carrev.2020.05.029] [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: 03/26/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome, yet its pathophysiology is only partially understood. We sought to assess the association between endothelial dysfunction (ED) and SCAD. METHODS We prospectively assessed patients presenting with acute coronary syndrome who were diagnosed with SCAD. The control arm had established coronary artery atherosclerotic disease (AD) according to previous coronary angiography. ED was assessed using the EndoPAT 2000 while patients returned to their steady state condition. A total of 16 patients with SCAD and 66 patients with AD were included. RESULTS Microvascular reactivity as assessed with the EndoPAT was significantly worse in the AD group compared to the SCAD group. The median RHI in the AD group was 1.76 (IQR 1.52, 2.2) vs. a median RHI of 2.08 (IQR 1.73, 2.79) in the SCAD group (p < 0.05). While the RHI values in half of the AD group (33 patients; 50%) were below the cut-off of 1.67 only one patient had an RHI below this cut-off in the SCAD group. CONCLUSIONS Patients with SCAD were not found to have ED and it is therefore unlikely that ED takes part in SCAD formation.
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Affiliation(s)
- Amir Solomonica
- Rambam Medical Center, Department of Cardiology, Haifa, Israel
| | - Cassandra Wagner
- Western University, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Shahar Lavi
- Western University, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
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Lavi S, Mehta SR, Bajwa R, Taleb H, Bakar SN, Sachedina A, Wagner C, Solomonica A, Awan K, Puka K, Garg P, Diamantouros P, Bagur R. Short Durations of Radial Hemostatic Device After Diagnostic Transradial Cardiac Catheterization: The PRACTICAL-2 Randomized Trial. Can J Cardiol 2020; 37:276-283. [PMID: 32335132 DOI: 10.1016/j.cjca.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Radial artery occlusion (RAO) is the most common complication following transradial approach (TRA) for cardiac catheterisation. Our aim was to assess if decreasing radial hemostatic device (RHD) time reduces the risk of RAO among individuals receiving small sheath sizes with no adjunctive heparin. METHODS We randomised 450 individuals undergoing diagnostic cardiac catheterization via TRA to 3 durations of RHD time: 10, 20, or 30 minutes. After these time periods, the RHD was gradually released over 20 minutes. The primary efficacy end point was forearm hematoma grade ≥ 2 (5-10 cm) and the primary safety end point was RAO (as determined by Doppler ultrasound) 1 hour after RHD removal (before discharge). RESULTS The mean age was 66 years and 64% were male. Five-French sheaths were used in all patients. Hematoma grade ≥ 2 occurred in only 1 patient, who was in the 20-minute group (P = 0.39). RAO occurred in 6.7% of patients in the 10-minute group, 10.7% in the 20-minute group and 6% in the 30-minute group (P = 0.26). CONCLUSIONS Among patients receiving small-caliber sheaths without adjunctive heparin, the incidence of forearm hematoma and RAO are low. Shorter durations of RHD time did not further reduce the risk of these complications.
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Affiliation(s)
- Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
| | - Shamir R Mehta
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Ontario, Canada
| | - Rehana Bajwa
- London Health Sciences Centre, London, Ontario, Canada
| | - Hussein Taleb
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Shahrukh N Bakar
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Ayaaz Sachedina
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | | | - Amir Solomonica
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Kokab Awan
- London Health Sciences Centre, London, Ontario, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Pallav Garg
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Pantelis Diamantouros
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Ontario, Canada
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Lavi S, Mehta SR, Bajwa R, Taleb H, Bakar SN, Sachedina A, Wagner C, Solomonica A, Awan K, Garg P, Diamantouros P, Bagur R. SHORT DURATIONS OF COMPRESSION HEMOSTATIC DEVICE APPLICATION POST TRANS-RADIAL CARDIAC CATHETERIZATION: THE PRACTICAL-2 TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bagur R, Solomonica A, Taleb H, Sanjoy S, Israeli Z, Lavi S. POSTPROCEDURAL RADIAL ARTERY COMPRESSION TIME IN CHRONIC ANTICOAGULATED PATIENTS USING STATSEAL. THE PRACTICAL-SEAL FEASIBILITY STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hage A, Giambruno V, Jones P, Chu MW, Fox S, Teefy P, Lavi S, Bainbridge D, Harle C, Iglesias I, Dobkowski W, Kiaii B. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis With Long-Term Follow-up. J Am Heart Assoc 2019; 8:e014204. [PMID: 31826727 PMCID: PMC6951054 DOI: 10.1161/jaha.119.014204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
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Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Vincenzo Giambruno
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Philip Jones
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Michael W Chu
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Stephanie Fox
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Patrick Teefy
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Shahar Lavi
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Christopher Harle
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Woijtecj Dobkowski
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
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Mohamed MO, Mamas MA, Nagaraja V, Alraies MC, Lamelas P, Tzemos N, Ayan D, Lavi S, Bagur R. Dedicated Bifurcation Stents for Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. J Invasive Cardiol 2019; 31:E344-E355. [PMID: 31786525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of coronary bifurcation lesions (CBL) remains a challenge in contemporary practice due to the procedural and technical difficulties involved. We sought to review the current evidence on the safety and clinical outcomes of dedicated bifurcation stent (DBS) implantation in comparison with established treatment strategies for CBL-PCI. METHODS We conducted a comprehensive search to identify randomized control trials (RCTs) reporting 1-year clinical and angiographic outcomes of patients undergoing CBL-PCI with DBS vs conventional CBL-PCI strategies. Random-effects meta-analyses were performed to estimate the effect of DBS compared with conventional CBL-PCI using aggregate data. RESULTS A total of 5 RCTs comprising 1249 participants met the inclusion criteria. The use of DBS was comparable to conventional stenting techniques in terms of major adverse cardiovascular event (MACE) rate (odds ratio [OR], 1.28; 95% confidence interval [CI], 0.90- 1.82; I²=0%), all-cause mortality (OR, 0.80; 95% CI, 0.31-2.07; I²=0%), cardiac mortality (OR, 0.16; 95% CI, 0.02-1.39; I²=0%), myocardial infarction (OR, 1.26; 95% CI, 0.84-1.89; I²=0%), definite stent thrombosis (OR, 1.75; 95% CI, 0.36-8.52; I²=0%), cumulative target-lesion revascularization (OR, 1.39; 95% CI, 0.85-2.27; I²=0%), clinically driven target-lesion revascularization (OR, 1.23; 95% CI, 0.68-2.22; I²=0%), or target-vessel revascularization (OR, 1.43; 95% CI, 0.92-2.22; I²=0%). CONCLUSION The present analysis suggests that CBL-PCI with DBS may be associated with similar 1-year clinical and angiographic outcomes compared with conventional CBL-PCI strategies. However, the low quality of evidence and limited follow-up warrant further studies to ascertain any significant differences in patient-important outcomes before the adoption of DBS into routine CBL-PCI practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Centre, 339 Windermere Road, N6A 5A5, London, Ontario, Canada.
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Mehta SR, Wood DA, Storey RF, Mehran R, Bainey KR, Nguyen H, Meeks B, Di Pasquale G, López-Sendón J, Faxon DP, Mauri L, Rao SV, Feldman L, Steg PG, Avezum Á, Sheth T, Pinilla-Echeverri N, Moreno R, Campo G, Wrigley B, Kedev S, Sutton A, Oliver R, Rodés-Cabau J, Stanković G, Welsh R, Lavi S, Cantor WJ, Wang J, Nakamya J, Bangdiwala SI, Cairns JA. Complete Revascularization with Multivessel PCI for Myocardial Infarction. N Engl J Med 2019; 381:1411-1421. [PMID: 31475795 DOI: 10.1056/nejmoa1907775] [Citation(s) in RCA: 458] [Impact Index Per Article: 91.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).
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Affiliation(s)
- Shamir R Mehta
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - David A Wood
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Robert F Storey
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Roxana Mehran
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Kevin R Bainey
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Helen Nguyen
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Brandi Meeks
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Giuseppe Di Pasquale
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Jose López-Sendón
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - David P Faxon
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Laura Mauri
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Sunil V Rao
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Laurent Feldman
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - P Gabriel Steg
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Álvaro Avezum
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Tej Sheth
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Natalia Pinilla-Echeverri
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Raul Moreno
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Gianluca Campo
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Benjamin Wrigley
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Sasko Kedev
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Andrew Sutton
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Richard Oliver
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Josep Rodés-Cabau
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Goran Stanković
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Robert Welsh
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Shahar Lavi
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Warren J Cantor
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Jia Wang
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Juliet Nakamya
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - Shrikant I Bangdiwala
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
| | - John A Cairns
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.)
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Solo K, Lavi S, Kabali C, Levine GN, Kulik A, John-Baptiste AA, Fremes SE, Martin J, Eikelboom JW, Ruel M, Huitema AA, Choudhury T, Bhatt DL, Tzemos N, Mamas MA, Bagur R. Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis. BMJ 2019; 367:l5476. [PMID: 31601578 PMCID: PMC6785742 DOI: 10.1136/bmj.l5476] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019. ELIGIBILITY CRITERIA: for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery. MAIN OUTCOME MEASURES The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death. RESULTS This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates. CONCLUSIONS The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes. STUDY REGISTRATION PROSPERO registration number CRD42017065678.
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Affiliation(s)
- Karla Solo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Cochrane Canada Center, MacGRADE Center and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Conrad Kabali
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Glenn N Levine
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ava A John-Baptiste
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anesthesia & Perioperative Medicine and Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anesthesia & Perioperative Medicine and Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, ON, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ashlay A Huitema
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Tawfiq Choudhury
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Tzemos
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
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Bakar S, Hayman S, McCarty D, Thain A, McLellan A, Wagner C, Lavi S. INVASIVE ASSESSMENT OF MICROVASCULAR RESISTANCE IN HYPERTROPHIC CARDIOMYOPATHY WITH ECHOCARDIOGRAPHIC CORRELATES. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Akl E, Dzavik V, Cairns J, Lavi S, Mehta S, Cantor W, Sibbald M, Cheema A, Welsh R, Sheth T, Bertrand O, Liu Y, Jolly S. HEART FAILURE IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION, PREDICTORS AND PROGNOSTIC IMPACT: INSIGHTS FROM THE TOTAL TRIAL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Akl E, Dzavik V, Cairns J, Lavi S, Mehta S, Cantor W, Sibbald M, Cheema A, Welsh R, Sheth T, Bertrand O, Rao S, Moreno R, Liu YY, Jolly S. TCT-487 Heart Failure in ST-Segment Elevation Myocardial Infarction, Predictors and Prognostic Impact: Insights From the TOTAL Trial. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.582] [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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Moxham R, Dzavik V, Cairns J, Natarajan M, Bainey K, Akl E, Tsang M, Lavi S, Cantor W, Liu Y, Jolly S. TIME AND MORTALITY IN ST ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE TOTAL TRIAL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Choudhury T, Lurz P, Schäufele TG, Menezes MN, Lavi S, Tzemos N, Hartung P, Stiermaier T, Makino K, Bertrand OF, Gilchrist IC, Mamas MA, Bagur R. Radial versus femoral approach for left ventricular endomyocardial biopsy. EUROINTERVENTION 2019; 15:678-684. [DOI: 10.4244/eij-d-18-01061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Affiliation(s)
- Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | | | | | - Sabrina Wall
- London Health Sciences Centre, London, Ontario, Canada
| | - Ronit Lavi
- London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
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Levi Y, Lavi S, Solomonica A, Israeli Z, Bagur R. Small-Size vs Large-Size Burr for Rotational Atherectomy. J Invasive Cardiol 2019; 31:183-186. [PMID: 31158807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rotational atherectomy (RA) has been traditionally performed via the transfemoral approach, mostly utilizing large guide catheters (≥7 Fr), which can accommodate the passage of large burrs (≥1.75 mm). However, contemporary data show that using smaller sheath and catheter sizes reduces the risk of procedural access-site related complications. Therefore, the aim of this study was to assess the feasibility of performing RA using smaller burrs and subsequently smaller-sized sheath catheters. METHODS A total of 220 patients underwent RA procedures between January 2011 and July 2017. We compared 162 patients who underwent RA using a maximal burr size of 1.5 mm (small-burr group) with 58 patients who underwent RA using burrs >1.5 mm in diameter (large-burr group). Clinical, procedural, safety, and feasibility data were evaluated and compared between the two groups. RESULTS Baseline characteristics of the two groups were quite similar other than a higher prevalence of smoking (21.0% vs 5.2%; P<.01) and a lower body weight (80.9 ± 17.5 kg vs 86.8 ± 17.2 kg; P=.03) in the small-burr group vs the large-burr group. The indications for the procedure for the small-burr group vs large-burr group were stable angina in 53% vs 62%, unstable angina in 16% vs 17%, non-ST elevation myocardial infarction (MI) in 26% vs 17%, and ST-elevation MI in 3.7% vs 3.4%, respectively (P=NS for all). The target-vessel (TV) diameter was significantly larger in the large-burr group vs the small-burr group (3.5 ± 0.3 mm vs 3.2 ± 0.5 mm, respectively; P<.01). Importantly, a sheath size >6 Fr was used in 56.0% of the small-burr group vs 89.5% of the large-burr group (P<.01). Moreover, in 53% of the small-burr group, a guide catheter >6 Fr was used. Radial access was used in 33% of the small-burr group and 17% of the large-burr group (P=.03). Procedural success was achieved in 93% of the small-burr group and 100% of the large-burr group (P=.07). CONCLUSION In the majority of cases, RA can be successfully performed using smaller-sized burrs while achieving a high procedural success rate. Notably, our study also highlights the overuse of large sheaths and catheters to deliver small burrs. These results further support the contemporary strategy of using 6 Fr guide catheters, thereby increasing the possibility of using the radial approach for more complex interventional procedures.
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Affiliation(s)
| | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada N6A 5A5.
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Alemayehu M, Kim RB, Lavi R, Gong I, D'Alfonso S, Mansell SE, Wall S, Lavi S. Effect of Ticagrelor Versus Clopidogrel on Vascular Reactivity. J Am Coll Cardiol 2019; 69:2246-2248. [PMID: 28449783 DOI: 10.1016/j.jacc.2017.02.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
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Welsh RC, Sidhu RS, Cairns JA, Lavi S, Kedev S, Moreno R, Cantor WJ, Stankovic G, Meeks B, Yuan F, Džavík V, Jolly SS. Outcomes Among Clopidogrel, Prasugrel, and Ticagrelor in ST-Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention From the TOTAL Trial. Can J Cardiol 2019; 35:1377-1385. [PMID: 31492492 DOI: 10.1016/j.cjca.2019.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Robust comparisons between oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) in ST-elevation myocardial infarction (STEMI) patients who undergo primary percutaneous coronary intervention are lacking. We sought to evaluate outcomes on the basis of P2Y12 inhibitor therapy in patients from the Thrombectomy With PCI Versus PCI Alone in Patients With STEMI Undergoing Primary PCI (TOTAL) trial. METHODS We grouped 9932 patients according to P2Y12 inhibitor at hospital discharge: clopidogrel (n = 6500; 65.5%), prasugrel (n = 1244; 12.5%), or ticagrelor (n = 2188; 22.0%). The primary composite end point of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association class IV heart failure was examined at 1 year. Secondary efficacy and safety end points were also assessed. Cox proportional hazard ratios were determined and adjusted for confounders via propensity scoring. RESULTS Baseline characteristics differing between the 3 groups were mainly age 75 years or older, diabetes, and previous stroke. After adjustment, ticagrelor use was associated with a lower rate of the primary composite outcome compared with clopidogrel (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.57-0.91; P < 0.02) and prasugrel (aHR, 0.65; 95% CI, 0.48-0.89; P = 0.02). Prasugrel use was not associated with a lower rate of the primary outcome compared with clopidogrel (aHR, 1.09; 95% CI, 0.86-1.39; P > 0.99). Neither prasugrel nor ticagrelor were associated with increased risk of stroke compared with clopidogrel. Compared with clopidogrel, ticagrelor was associated with significantly lower rates of major bleeding. CONCLUSIONS In this observational analysis of STEMI patients who underwent primary percutaneous coronary intervention, ticagrelor was associated with improved outcomes compared with clopidogrel and prasugrel. An appropriately powered randomized trial is needed to confirm these findings.
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Affiliation(s)
- Robert C Welsh
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada.
| | - Robinder S Sidhu
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
| | - Sasko Kedev
- University Clinic of Cardiology, Sts Curil and Methodius University, Skopje, Macedonia
| | | | - Warren J Cantor
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Brandi Meeks
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Fei Yuan
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sanjit S Jolly
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Allahwala UK, Jolly SS, Džavík V, Cairns JA, Kedev S, Balasubramanian K, Stankovic G, Moreno R, Valettas N, Bertrand O, Lavi S, Velianou JL, Sheth T, Meeks B, Brilakis ES, Bhindi R. The Presence of a CTO in a Non-Infarct-Related Artery During a STEMI Treated With Contemporary Primary PCI Is Associated With Increased Rates of Early and Late Cardiovascular Morbidity and Mortality: The CTO-TOTAL Substudy. JACC Cardiovasc Interv 2019; 11:709-711. [PMID: 29622151 DOI: 10.1016/j.jcin.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
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Saw J, Starovoytov A, Humphries K, Sheth T, So D, Minhas K, Brass N, Lavoie A, Bishop H, Lavi S, Pearce C, Renner S, Madan M, Welsh RC, Lutchmedial S, Vijayaraghavan R, Aymong E, Har B, Ibrahim R, Gornik HL, Ganesh S, Buller C, Matteau A, Martucci G, Ko D, Mancini GBJ. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J 2019; 40:1188-1197. [PMID: 30698711 PMCID: PMC6462308 DOI: 10.1093/eurheartj/ehz007] [Citation(s) in RCA: 241] [Impact Index Per Article: 48.2] [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: 08/22/2018] [Revised: 11/06/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) was underdiagnosed and poorly understood for decades. It is increasingly recognized as an important cause of myocardial infarction (MI) in women. We aimed to assess the natural history of SCAD, which has not been adequately explored. METHODS AND RESULTS We performed a multicentre, prospective, observational study of patients with non-atherosclerotic SCAD presenting acutely from 22 centres in North America. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, in-hospital characteristics, precipitating/predisposing conditions, angiographic features (assessed by core laboratory), in-hospital major adverse events (MAE), and 30-day major adverse cardiovascular events (MACE). We prospectively enrolled 750 SCAD patients from June 2014 to June 2018. Mean age was 51.8 ± 10.2 years, 88.5% were women (55.0% postmenopausal), 87.7% were Caucasian, and 33.9% had no cardiac risk factors. Emotional stress was reported in 50.3%, and physical stress in 28.9% (9.8% lifting >50 pounds). Predisposing conditions included fibromuscular dysplasia 31.1% (45.2% had no/incomplete screening), systemic inflammatory diseases 4.7%, peripartum 4.5%, and connective tissue disorders 3.6%. Most were treated conservatively (84.3%), but 14.1% underwent percutaneous coronary intervention and 0.7% coronary artery bypass surgery. In-hospital composite MAE was 8.8%; peripartum SCAD patients had higher in-hospital MAE (20.6% vs. 8.2%, P = 0.023). Overall 30-day MACE was 8.8%. Peripartum SCAD and connective tissue disease were independent predictors of 30-day MACE. CONCLUSION Spontaneous coronary artery dissection predominantly affects women and presents with MI. Despite majority of patients being treated conservatively, survival was good. However, significant cardiovascular complications occurred within 30 days. Long-term follow-up and further investigations on management are warranted.
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Affiliation(s)
- Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada
| | - Andrew Starovoytov
- Division of Cardiology, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada
| | - Karin Humphries
- BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Tej Sheth
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Derek So
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kunal Minhas
- Saint Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Neil Brass
- Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Andrea Lavoie
- University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada
| | - Helen Bishop
- Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
| | - Colin Pearce
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | | | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | | | - Eve Aymong
- St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Bryan Har
- Foothills Hospital, Calgary, Alberta, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | | | | | | | - Alexis Matteau
- Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | | | - Dennis Ko
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Israeli Z, Lavi S, Pancholy SB, Nombela-Franco L, Gilchrist IC, Gilchrist IC, Aldazabal A, Sharabi-Nov A, Levi Y, Hayman S, Tzemos N, Ayán D, Mamas MA, Bagur R. Radial versus femoral approach for saphenous vein grafts angiography and interventions. Am Heart J 2019; 210:1-8. [PMID: 30711875 DOI: 10.1016/j.ahj.2018.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Coronary angiography and intervention to saphenous venous grafts (SVGs) remain challenging. This study aimed to investigate the feasibility and safety of the radial approach compared to femoral access in a large cohort of patients undergoing SVG angiography and intervention. METHODS Data from 1,481 patients from Canada, United States, and Spain who underwent procedures between 2010 and 2016 were collected. Patients must have undergone SVG coronary angiography and/or intervention. Demographics, procedural data, and in-hospital complications were recorded. RESULTS Procedures were undertaken by either the radial (n = 863, 211 intervention) or femoral (n = 618, 260 intervention) approach. The mean number of SVGs per patient was similar between groups (radial 2.3 ± 0.7 vs femoral 2.6 ± 1.1, P = .61), but the radial group required a fewer number of catheters (2.6 ± 1.7 vs 4.1 ± 1.1, P < .001). Fluoroscopy time was comparable between groups, and there was a trend toward lower contrast volume in the radial group (P = .045). Overall, the total dose of heparin was significantly higher in the radial group (P < .001); however, radial patients experienced significantly less access-site bleeding complications (P < .001). Outpatients undergoing radial SVG interventions had a higher likelihood of a same-day discharge home (P < .001). CONCLUSIONS Radial access for SVG angiography and intervention is safe and feasible, without increasing fluoroscopy time. In experienced centers, radial access was associated with fewer catheters used, lower contrast volume, and lower rate of vascular access-site bleeding complications. Moreover, outpatients undergoing SVG percutaneous coronary intervention though the radial approach had a higher likelihood of a same-day discharge home.
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Solo K, Lavi S, Choudhury T, Martin J, Nevis IF, Kwok CS, Kotronias RA, Nishina N, Sponga S, Ayan D, Tzemos N, Mamas MA, Bagur R. Erratum to pre-operative use of aspirin in patients undergoing coronary artery bypass grafting: a systematic review and updated meta-analysis. J Thorac Dis 2019; 10:E860. [PMID: 30746279 DOI: 10.21037/jtd.2018.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/jtd.2018.05.187.].
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Affiliation(s)
- Karla Solo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Janet Martin
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Anesthesia & Perioperative Medicine, Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Rafail A Kotronias
- Oxford University Clinical Academic Graduate School, Oxford University, Oxford, UK
| | - Natsumi Nishina
- Faculty of International Communication, Gunma Prefectural Women's University, Tamamura, Gunma, Japan
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Diana Ayan
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Choudhury T, Solomonica A, Bagur R, Lavi S. Intravascular imaging for cardiac arrest with “normal” coronary arteriography. Cardiovascular Revascularization Medicine 2018; 19:53-55. [DOI: 10.1016/j.carrev.2018.04.016] [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] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
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Jaidka A, Zhu T, Lavi S, Johri A. TREATMENT OF LEFT VENTRICULAR THROMBUS USING WARFARIN VERSUS DIRECT ORAL ANTICOAGULANTS FOLLOWING ANTERIOR MYOCARDIAL INFARCTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sin P, Yang A, Pon Q, Lavoie A, Crawford J, Harenberg S, Zimmermann R, Booker J, Kelly S, Lavi S, Cantor W, Mehta S, Bagai A, Goodman S, Cheema A, Dehghani P. EFFECTS OF BASELINE PLATELET REACTIVITY IN FIBRINOLYSIS-TREATED ST ELEVATION MYOCARDIAL INFARCTION PATIENTS UNDERGOING EARLY PERCUTANEOUS CORONARY INTERVENTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Solomonica A, Lavi S, Choudhury T, Bagur R. An atypical presentation of acute coronary syndrome. J Thorac Dis 2018; 10:E616-E619. [PMID: 30233897 DOI: 10.21037/jtd.2018.07.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Yang A, Pon Q, Lavoie A, Crawford JJ, Harenberg S, Zimmermann RH, Booker J, Kelly S, Lavi S, Cantor WJ, Mehta SR, Bagai A, Goodman SG, Cheema AN, Dehghani P. Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI. J Thromb Thrombolysis 2018; 45:225-233. [PMID: 29170875 DOI: 10.1007/s11239-017-1581-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3-168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = - 189.7; p < 0.001) to 24 h (71.7 vs. 27.7; Mdiff = - 44.0; p < 0.001) to end of follow-up (27.7 vs.17.9; Mdiff = - 9.9. p = 0.016) for those randomized to Ticagrelor and significant decreases in PRU only from baseline to 4 h (271.3 vs. 200.8; Mdiff = - 70.5, p = < 0.001) in patients receiving Clopidogrel, and a significantly greater proportion of patients with adequate platelet inhibition (PRU < 208) on long-term follow-up (Clopidogrel, 82.6% vs. Ticagrelor, 100.0%; p = 0.038). Our results demonstrate that in patients undergoing PCI within 24 h of fibrinolysis for STEMI, Ticagrelor provides prolonged platelet inhibition compared with Clopidogrel.
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Affiliation(s)
- Andrew Yang
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Quin Pon
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Andrea Lavoie
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Jennifer J Crawford
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Sebastian Harenberg
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Rodney H Zimmermann
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Jeff Booker
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Sheila Kelly
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Shahar Lavi
- London Health Sciences, University of London, London, ON, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada
| | - Shamir R Mehta
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Asim N Cheema
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Payam Dehghani
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada.
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Choudhury T, Hayman S, McLellan A, Bagur R, Lavi S, Solomonica A, Zeev Israeli, Yadegari A, McPherson T, Teefy P, Garg P. TCT-247 Reducing Radiation Exposure to Operators During Invasive Cardiac Procedures with a Novel Lead-Based Arm-Board (RADAR). J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Gebhard C, Rhainds D, He G, Rodés-Cabau J, Lavi S, Spence JD, Title L, Kouz S, L'Allier PL, Grégoire J, Ibrahim R, Cossette M, Guertin MC, Beanlands R, Rhéaume E, Tardif JC. Elevated level of lecithin:cholesterol acyltransferase (LCAT) is associated with reduced coronary atheroma burden. Atherosclerosis 2018; 276:131-139. [DOI: 10.1016/j.atherosclerosis.2018.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
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