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4. Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk

Author

Smits, Pieter C., Frigoli, Enrico, VRANCKX, Pascal, Ozaki, Yukio, Morice, Marie -Claude, Chevalier, Bernard, Onuma, Yoshinobu, Windecker, Stephan, Tonino, Pim A. L., Roffi, Marco, Lesiak, Maciej, Mahfoud, Felix, Bartunek, Jozef, Hildick-Smith, David, Colombo, Antonio, Stankovic, Goran, Iniguez, Andres, Schultz, Carl, Kornowski, Ran, Ong, Paul J. L., Alasnag, Mirvat, Rodriguez, Alfredo E., Paradies, Valeria, Kala, Petr, Kedev, Sasko, Al Mafragi, Amar, Dewilde, Willem, Heg, Dik, Valgimigli, Marco, MASTER DAPT Investigators, Schultz, Carl/0000-0002-0847-4361, Smits, Pieter C., Frigoli, Enrico, VRANCKX, Pascal, Ozaki, Yukio, Morice, Marie -Claude, Chevalier, Bernard, Onuma, Yoshinobu, Windecker, Stephan, Tonino, Pim A. L., Roffi, Marco, Lesiak, Maciej, Mahfoud, Felix, Bartunek, Jozef, Hildick-Smith, David, Colombo, Antonio, Stankovic, Goran, Iniguez, Andres, Schultz, Carl, Kornowski, Ran, Ong, Paul J. L., Alasnag, Mirvat, Rodriguez, Alfredo E., Paradies, Valeria, Kala, Petr, Kedev, Sasko, Al Mafragi, Amar, Dewilde, Willem, Heg, Dik, Valgimigli, Marco, and MASTER DAPT Investigators

Subjects
percutaneous coronary intervention, 610 Medicine & health, 610 Medizin und Gesundheit, Cardiology and Cardiovascular Medicine, dual antiplatelet therapy, antiplatelet therapy, acute coronary syndrome
Abstract

BACKGROUND The optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk (HBR) presenting with an acute coronary syndrome remains unclear.OBJECTIVES The objective of this study was to investigate the safety and efficacy of an abbreviated APT regimen after coronary stenting in an HBR population presenting with acute or recent myocardial infarction.METHODS In the MASTER DAPT trial, 4,579 patients at HBR were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months single APT or 5 months in patients with oral anticoagulants) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction at index procedure. Coprimary outcomes at 335 days after randomization were net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium bleeding.RESULTS NACE and MACCE did not differ with abbreviated vs nonabbreviated APT regimens in patients with an acute or recent myocardial infarction (n =1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or without an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Bleeding Academic Research Consortium 2, 3, or 5 bleeding was signifi-cantly reduced in patients with or without an acute or recent myocardial infarction (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72) with abbreviated APT.CONCLUSIONS A 1-month DAPT strategy in patients with HBR presenting with an acute or recent myocardial infarction results in similar NACE and MACCE rates and reduces bleedings compared with a nonabbreviated DAPT strategy. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020) (J Am Coll Cardiol 2022;80:1220-1237) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Published
2022

5. Animal-vehicle collisions during the COVID-19 lockdown in early 2020 in the Krakow metropolitan region, Poland

Author

Basak, Sayantani M., O'Mahony, Declan T., Lesiak, Maciej, Basak, Arpan Kumar, Ziółkowska, Elżbieta, Kaim, Dominik, Hossain, Md Sarwar, and Wierzbowska, Izabela A.

Subjects
Multidisciplinary, Communicable Disease Control, Animals, COVID-19, Animals, Wild, Poland, Pandemics
Abstract

The interrelations between human activity and animal populations are of increasing interest due to the emergence of the novel COVID-19 and the consequent pandemic across the world. Anthropogenic impacts of the pandemic on animals in urban-suburban environments are largely unknown. In this study, the temporal and spatial patterns of urban animal response to the COVID-19 lockdown were assessed using animal-vehicle collisions (AVC) data. We collected AVC data over two 6-month periods in 2019 and 2020 (January to June) from the largest metropolis in southern Poland, which included lockdown months. Furthermore, we used traffic data to understand the impact of lockdown on AVC in the urban area. Our analysis of 1063 AVC incidents revealed that COVID-19 related lockdown decreased AVC rates in suburban areas. However, in the urban area, even though traffic volume had significantly reduced, AVC did not decrease significantly, suggesting that lockdown did not influence the collision rates in the urban area. Our results suggest that there is a need to focus on understanding the effects of changes in traffic volume on both human behaviour and wildlife space use on the resulting impacts on AVC in the urban area.

Published
2022

6. Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions:Predictors of Procedural Success From the ERCTO Registry

Author

Myat, Aung, Galassi, Alfredo R., Werner, Gerald S., Mashayekhi, Kambis, Avran, Alexandre, Boudou, Nicolas, Meyer-Gessner, Markus, Reifart, Nicolaus, Lesiak, Maciej, Garbo, Roberto, Bufe, Alexander, Spratt, James, Bryniarski, Leszek, Christiansen, Evald H., Sianos, Georgios, Escaned, Javier, Di Mario, Carlo, and Hildick-Smith, David

Subjects
coronary collateral, percutaneous coronary intervention, retrograde, chronic total occlusion, antegrade
Abstract

Objectives: The aim of this study was to identify independent predictors of procedural success after retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: Retrograde CTO PCI is an established technique, but predictors of success remain poorly understood. Methods: A multivariable logistic regression model was used to analyze potentially important demographic, clinical, anatomical, and technical aspects of retrograde CTO PCI cases uploaded to the multicenter European CTO (ERCTO) Club Registry. Results: In calendar years 2018 and 2019, 2,364 retrograde CTO PCI cases constituted the primary analysis cohort. A primary retrograde strategy was used in 1,953 cases (82.6%), and an initial antegrade approach was converted to retrograde in 411 cases (17.4%). Procedural success was achieved in 1,820 cases (77.0%) and was more likely to occur after a primary retrograde attempt versus conversion from an initial antegrade approach (80.9% vs 58.4%; P < 0.0001). After multivariable analysis, an absence of lesion calcification (OR: 1.86; 95% CI: 1.37-2.51; P < 0.0001), a higher degree of distal vessel opacification (OR: 2.47; 95% CI: 1.72-3.55; P < 0.0001), little or no proximal target vessel tortuosity (OR: 1.84; 95% CI: 1.28-2.64; P = 0.001), Werner collateral connection CC1 (OR: 4.87; 95% CI: 2.90-8.19; P < 0.0001) or CC2 (OR: 5.33; 95% CI: 3.02-9.42; P < 0.0001), and the top tertile of operator volume (>120 cases over 2 years) (OR: 1.88; 95% CI: 1.26-2.79; P = 0.002) were associated with the greatest chance of achieving angiographic success. Conclusions: Less calcification with good distal vessel opacification, little or absent proximal vessel tortuosity, and visible collateral connections, along with high-volume operator status, were all independently predictive of angiographically successful retrograde CTO PCI.

Published
2022

7. Dual antiplatelet therapy for reduction in mortality in patients with acute and chronic coronary syndromes

Author

Lesiak, Maciej and Komosa, Anna

Subjects
Review Paper, clopidogrel, acute coronary syndromes, cardiovascular diseases, Cardiology and Cardiovascular Medicine, mortality, antiplatelet therapy, ticagrelor
Abstract

Dual antiplatelet therapy (DAPT) is a foundation of successful coronary artery disease management. DAPT is recommended according to ESC guidelines for 6 months following elective percutaneous coronary intervention and for 12 months following the acute coronary syndrome (ACS). ACS are the most cost-consuming type of the ischemic heart disease, which prominently requires hospital treatment. This risk significantly increases shortly after stopping DAPT, which is typical in most patients after 12 months following acute myocardial infarction (AMI). Therefore, one of the goals of long-term treatment of such patients should be the identification of those at increased risk of subsequent events, for whom prolonged DAPT will bring clinical benefits. It has been documented that prasugrel and ticagrelor, compared to clopidogrel, significantly reduce the incidence of major adverse cardiovascular events (MACE) in ACS patients. In addition to lowering composite ischemic endpoint, ticagrelor significantly reduced all-cause and cardiovascular mortality. The long-term use of ticagrelor in patients with a previous myocardial infarction was also related to a significant reduction in MACE. In patients who had a myocardial infarction 1-3 years earlier, the addition of ticagrelor to aspirin resulted in a substantial reduction in the composite endpoint of cardiovascular death, myocardial infarction, or stroke at the expense of a small but significant increase in bleedings. Hypothetical calculations have shown that replacing clopidogrel with ticagrelor in all patients with AMI in Poland would save more than three thousand lives within 12 months after AMI and more than a thousand within the following 2 years.

Published
2021

8. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure

Author

Krysztofiak, Helena, Wleklik, Marta, Migaj, Jacek, Dudek, Magdalena, Uchmanowicz, Izabella, Lisiak, Magdalena, Kubielas, Grzegorz, Straburzyńska-Migaj, Ewa, Lesiak, Maciej, and Kałużna-Oleksy, Marta

Subjects
Heart Failure, Aging, Sarcopenia, Cachexia, Review, Comorbidity, cardiac cachexia, musculoskeletal system, Prognosis, nutritional status, Europe, Risk Factors, Chronic Disease, Quality of Life, Humans
Abstract

Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).

Published
2020

9. The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial: A Prospective Pilot Experience

Author

Ninomiya, Kai, Serruys, Patrick W., Garg, Scot, Hara, Hironori, Masuda, Shinichiro, Kageyama, Shigetaka, Kotoku, Nozomi, Sevestre, Emelyne, Kumar, Abhishek, O’Kane, Peter, Zaman, Azfar, Farah, Bruno, Magro, Michael, Oemrawsingh, Rohit M., Möllmann, Helge, Meneveau, Nicolas, Achenbach, Stephan, Lemoine, Julien, Allali, Abdelhakim, Gallagher, Sean, Wykrzykowska, Joanna, Lesiak, Maciej, Silvestri, Marc, Wijns, William, Sharif, Faisal, Onuma, Yoshinobu, Graduate School, ACS - Heart failure & arrhythmias, and ACS - Atherosclerosis & ischemic syndromes

Subjects
MORTALITY, STENT, risk stratification, General Medicine, MYOCARDIAL REVASCULARIZATION, DECISION-MAKING, GUIDELINES, THERAPY, VALIDATION, SYNTAX score, ARTERY-BYPASS SURGERY, cardiovascular diseases, percutaneous coronary intervention (PCI), Cardiology and Cardiovascular Medicine, coronary artery bypass grafts (CABG)
Abstract

Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the “on site” heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 ± 4.6% vs 6.0 ± 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 ± 3.5% vs 3.7 ± 3.0%, p = 0.008) and 10-years (9.3 ± 4.8% vs 6.2 ± 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD] 4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. Clinical Trial Registration: ClinicalTrials.gov reference: NCT04390672.

Published
2022

10. Sex-related differences and rotational atherectomy : analysis of 5 177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020

Author

Sabatowski, Karol, Malinowski, Krzysztof, Siudak, Zbigniew, Reczuch, Krzysztof, Dobrzycki, Sławomir, Lesiak, Maciej, Hawranek, Michał, Gil, Robert Julian, Witkowski, Adam, Wojakowski, Wojciech, Lekston, Andrzej, Gąsior, Mariusz, Wańha, Wojciech, Legutko, Jacek, Ekkert, Michał, Jędrychowska, Magdalena, Chyrchel, Michał, Surdacki, Andrzej, Bartuś, Stanisław, and Januszek, Rafał Adam

Published
2021

12. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure

Author

Krysztofiak,Helena, Wleklik,Marta, Migaj,Jacek, Dudek,Magdalena, Uchmanowicz,Izabella, Lisiak,Magdalena, Kubielas,Grzegorz, Straburzyńska-Migaj,Ewa, Lesiak,Maciej, and Kałużna-Oleksy,Marta

Subjects
Clinical Interventions in Aging
Abstract

Helena Krysztofiak,1 Marta Wleklik,2 Jacek Migaj,1,3 Magdalena Dudek,1,3 Izabella Uchmanowicz,2 Magdalena Lisiak,2 Grzegorz Kubielas,2 Ewa Straburzyńska-Migaj,1,3 Maciej Lesiak,1,3 Marta Kałużna-Oleksy1,3 1 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland; 2Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland; 3Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, Poznan, PolandCorrespondence:Izabella Uchmanowicz Department of Clinical Nursing, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, PolandTel +48 71 784 18 05Fax +48 71 345 93 24Email izabella.uchmanowicz@umed.wroc.plAbstract: Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).Keywords: cardiac cachexia, heart failure, nutritional status

Published
2020

14. 12 months outcomes after Bioresorbable Vascular Scaffold implantation in Patients with Acute Coronary Syndromes. Data from the European Multicentre GHOST-EU Extended Registry

Author

Schnorbus, Boris, Wiebe, Jens, Capodanno, Davide, Brugaletta, Salvatore, Geraci, Salvatore, Mehilli, Julinda, Latib, Azeem, Lesiak, Maciej, Jensen, Christoph, Mattesini, Alessio, Münzel, Thomas, Capranzano, Piera, Di Mario, Carlo, Naber, Christoph, Araszkiewicz, Aleksander, Caramanno, Giuseppe, Sabate, Manel, Tamburino, Corrado, Nef, Holger, Gori, Tommaso, COLOMBO, ANTONIO, Schnorbus, Bori, Wiebe, Jen, Capodanno, Davide, Brugaletta, Salvatore, Geraci, Salvatore, Mehilli, Julinda, Latib, Azeem, Lesiak, Maciej, Jensen, Christoph, Mattesini, Alessio, Münzel, Thoma, Capranzano, Piera, Di Mario, Carlo, Naber, Christoph, Araszkiewicz, Aleksander, Colombo, Antonio, Caramanno, Giuseppe, Sabate, Manel, Tamburino, Corrado, Nef, Holger, and Gori, Tommaso

Abstract

We report on the mid-term outcomes of patients undergoing percutaneous coronary intervention with bioresorbable vascular scaffolds (BVS) for the treatment of acute coronary syndromes (ACS) and compare with those of patients with stable coronary artery disease (sCAD).

Published
2017

15. Bioresorbable vascular scaffold use for coronary bifurcation lesions: A substudy from GHOST EU registry

Author

Naganuma, Toru, Lesiak, Maciej, Capodanno, Davide, Gori, Tommaso, Nef, Holger, Caramanno, Giuseppe, Naber, Christoph, Di Mario, Carlo, Ruparelia, Neil, Capranzano, Piera, Wiebe, Jens, Araszkiewicz, Aleksander, Geraci, Salvatore, Kawamoto, Hiroyoshi, Pyxaras, Stelios, Mattesini, Alessio, Mã¼nzel, Thomas, Tamburino, Corrado, Latib, Azeem, COLOMBO, ANTONIO, Naganuma, Toru, Colombo, Antonio, Lesiak, Maciej, Capodanno, Davide, Gori, Tommaso, Nef, Holger, Caramanno, Giuseppe, Naber, Christoph, Di Mario, Carlo, Ruparelia, Neil, Capranzano, Piera, Wiebe, Jen, Araszkiewicz, Aleksander, Geraci, Salvatore, Kawamoto, Hiroyoshi, Pyxaras, Stelio, Mattesini, Alessio, Mã¼nzel, Thoma, Tamburino, Corrado, and Latib, Azeem

Subjects
Male, Registrie, Radiology, Nuclear Medicine and Imaging, Coronary Thrombosi, Time Factor, Coronary Artery Disease, Kaplan-Meier Estimate, bioresorbable vascular scaffold, coronary bifurcation, scaffold thrombosis, Coronary Angiography, Prosthesis Design, Retrospective Studie, Absorbable Implant, Stent, Acute Coronary Syndrome, Angioplasty, Balloon, Coronary, Multivariate Analysi, Ultrasonography, Interventional, Aged, Risk Factor, Middle Aged, Europe, Treatment Outcome, Proportional Hazards Model, Female, scaffold thrombosi, Cardiology and Cardiovascular Medicine, Tomography, Optical Coherence, Human
Abstract

Objectives: The aim of this study was to evaluate midterm outcomes of bioresorbable vascular scaffolds (BVS) implanted in bifurcation lesions. Background: BVS have emerged as an alternative to conventional metallic drug-eluting stents for the treatment of coronary complex lesions. Methods: Between November 2011 and January 2014, 1189 patients underwent percutaneous coronary intervention with BVS at 10 European centers (GHOST EU registry). Of these, 289 consecutive patients (302 bifurcation lesions) treated with either single-stenting (n = 260) or double-stenting (n = 42) were evaluated. Results: True bifurcations were treated in 44.7%. Intravascular ultrasound and optical coherence tomography were utilized only in 22.2% and 21.2%, respectively. Predilation was performed in 95.4%, while postdilation of the main branch was performed in 61.3%. Final kissing inflation with no or minimal protrusion of a side-branch balloon into main branch was performed in 18.9%. Median follow-up period was 356 (IQR 191–419) days. The Kaplan–Meier estimated rates of target lesion failure and scaffold thrombosis (ST) were 6.4% and 2.5% at 360 days, respectively. Independent predictors for TLF were ACS and diabetes mellitus (HR 4.67; 95% CI: 1.78–12.3; P = 0.002 and HR 3.37; 95% CI: 1.38–8.26; P = 0.008, respectively). Conclusions: BVS use for coronary bifurcation lesions in an “all-comer” population was associated with acceptable TLF rates up to midterm follow-up. However, ST rates were higher than seen with contemporary metallic stents possibly due to the low incidence of intravascular guidance and postdilation resulting in a higher likelihood of scaffold underexpansion and malapposition, further supporting the importance of meticulous implantation technique. © 2016 Wiley Periodicals, Inc.

Published
2017

18. Long Coronary Lesions Treated With Thin Strut Bioresorbable Polymer Drug Eluting Stent: Experience From Multicentre Randomized CENTURY II Study

Author

Lesiak, Maciej, Araszkiewicz, Aleksander, Grajek, Stefan, Colombo, Antonio, Lalmand, Jacques, Carstensen, Steen, Namiki, Atsuo, Tobaru, Tetsuya, Merkely, Béla, Moreno, Raul, Wijns, William, Saito, Shigeru, BARBATO, EMANUELE, Lesiak, Maciej, Araszkiewicz, Aleksander, Grajek, Stefan, Colombo, Antonio, Lalmand, Jacque, Carstensen, Steen, Namiki, Atsuo, Tobaru, Tetsuya, Merkely, Béla, Moreno, Raul, Barbato, Emanuele, Wijns, William, and Saito, Shigeru

Abstract

To assess performance of new, bioresorbable polymer sirolimus-eluting stent (BP-SES), in patients with long coronary lesions (LL) and to compare it to permanent polymer everolimus-eluting stent (PP-EES).

Published
2016

19. Segmental comparison between a dedicated bifurcation stent and balloon angioplasty using intravascular ultrasound and three-dimensional quantitative coronary angiography : A subgroup analysis of the Tryton IDE randomized trial

Author

Grundeken, Maik J., Garcia-Garcia, Hector M., Kumsars, Indulis, Lesiak, Maciej, Kayaert, Peter, Dens, Jo, Stella, Pieter R., de Winter, Robbert J., Laak, Linda L., Généreux, Philippe, Kaplan, Aaron V., Leon, Martin B., Wykrzykowska, Joanna J., Onuma, Yoshinobu, Serruys, Patrick W., Cardio-vascular diseases, Clinical sciences, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias

Subjects
Coronary bifurcation lesion, IVUS, Multicenter Study, Radiology Nuclear Medicine and imaging, Randomized Controlled Trial, Journal Article, Comparative Study, TRYTON, Cardiology and Cardiovascular Medicine, Side branch balloon angioplasty
Abstract

Objective: Randomized comparison between the Tryton Side Branch Stent (Tryton Medical, Durham, NC), used in combination with a main branch drug-eluting stent (DES), and side branch balloon angioplasty (SBBA, in combination with a main branch DES) using intravascular ultrasound (IVUS), and three-dimensional quantitative coronary angiography (3D-QCA). Background: The Tryton stent has been developed to improve clinical outcomes after percutaneous coronary intervention (PCI) of bifurcation lesions. Methods: We present the pre-specified IVUS (n=159) and 3D-QCA (n=190) sub-group analyses of the Tryton coronary bifurcation trial (randomizing Tryton vs. SBBA). Results: There were no differences in the main branch with regard to minimal lumen area (MLA) (5.33 +/- 1.37 in Tryton vs. 5.69 +/- 1.72 mm(2) in SBBA, P=0.235) with low neo-intima area in both groups. In the side branch, there were also no statistical significant differences between both groups (3.0461.02 in Tryton vs. 3.46 +/- 1.15 mm 2 in SBBA, P=0.072). On 3D-QCA, no differences in minimal lumen diameter (MLD) and percentage diameter stenosis (% DS) were observed in the proximal and distal main branches. In the side branch, there were also no differences found in % DS and MLD (MLD: 1.34 +/- 0.043 mm [Tryton] vs. 1.45 +/- 0.31 mm [SBBA], P=0.090). Conclusions: There were no differences in 9-month luminal dimensions of the side branch between the Tryton Stent and Side Branch Balloon Angioplasty, as assessed with IVUS (MLA) and 3D QCA (MLD). Angiographic and ultrasound results of the main branch were not negatively influenced by the Tryton stent. (C) 2016 Wiley Periodicals, Inc

Published
2017

22. Outcomes of a Dedicated Stent in Coronary Bifurcations with Large Side Branches: A Subanalysis of the Randomized TRYTON Bifurcation Study

Author

Généreux, Philippe, Kini, Annapoorna, Lesiak, Maciej, Kumsars, Indulis, Fontos, Géza, Slagboom, Ton, Ungi, Imre, Metzger, D. Christopher, Wykrzykowska, Joanna J., Stella, Pieter R., Bartorelli, Antonio L., Fearon, William F., Lefèvre, Thierry, Feldman, Robert L., Tarantini, Giuseppe, Bettinger, Nicolas, Minalu Ayele, Girma, LaSalle, Laura, Francese, Dominic P., Onuma, Yoshinobu, Grundeken, Maik J., Garcia-Garcia, Hector M., Laak, Linda L., Cutlip, Donald E., Kaplan, Aaron V., Serruys, Patrick W., Leon, Martin B., and Cardiology

Subjects
Male, Time Factors, Myocardial Infarction, Coronary Artery Disease, Coronary Angiography, Prosthesis Design, Severity of Illness Index, coronary stent, Risk Factors, Nuclear Medicine and Imaging, Journal Article, Humans, Comparative Study, Single-Blind Method, Prospective Studies, Angioplasty, Balloon, Coronary, coronary bifurcation, Aged, Medicine (all), Coronary Thrombosis, Coronary Stenosis, PCI, Middle Aged, Radiology, Nuclear Medicine and Imaging, Cardiology and Cardiovascular Medicine, Multicenter Study, Treatment Outcome, Radiology Nuclear Medicine and imaging, Randomized Controlled Trial, Female, Stents, Radiology
Abstract

Objectives: To examine the benefit of the Tryton dedicated side branch (SB) stent compared with provisional stenting in the treatment of complex bifurcation lesions involving large SBs. Background: The TRYTON Trial was designed to evaluate the utility of a dedicated SB stent to treat true bifurcation lesions involving large (≥2.5 mm by visual estimation) SBs. Patient enrolled in the trial had smaller SB diameters than intended (59% SB ≤2.25 mm by Core Lab QCA). The TRYTON Trial did not meet its primary endpoint due to an increased rate of peri-procedural myocardial infarctions (MIs). Methods: The TRYTON Trial randomized 704 patients to the Tryton SB stent with main vessel DES versus provisional SB treatment with main vessel DES. The rates of the primary end point of target vessel failure and the secondary powered end point of angiographic percent diameter stenosis in the SB at 9 months were assessed and compared between the two treatment strategies among patients with a SB ≥2.25 mm diameter at baseline determined by Core Lab QCA. Results: Among the 704 patients enrolled in the TRYTON Trial, 289 patients (143 provisional and 146 Tryton stent; 41% of entire cohort) had a SB ≥2.25 mm. The primary end point of TVF was numerically lower in the Tryton group compared with the provisional group (11.3% vs. 15.6%, P = 0.38), and was within the non-inferiority margin. No difference among the rates of clinically driven target vessel revascularization (3.5% vs. 4.3% P = 0.77) or cardiac death (0% both groups) were seen. In-segment percent diameter stenosis of the SB was significantly lower in the Tryton group compared with the provisional group (30.4% vs. 40.6%, P = 0.004). Conclusions: Analysis of the TRYTON Trial cohort of SB ≥2.25 mm supports the safety and efficacy of the Tryton SB stent compared with a provisional stenting strategy in the treatment of bifurcation lesions involving large SBs.

Published
2016

24. Placement of Tryton Side Branch Stent only; a new treatment strategy for Medina 0,0,1 coronary bifurcation lesions

Author

Grundeken, Maik J., Agostoni, Pierfrancesco, Lesiak, Maciej, Koch, Karel T., Voskuil, Michiel, de Winter, Robbert J., Wykrzykowska, Joanna J., Stella, Pieter R., Cardiology, and Amsterdam Cardiovascular Sciences

Abstract

We propose a new treatment strategy of Medina 0,0,1 bifurcation lesions using a dedicated side branch stent alone (Tryton Side Branch Stent™) without additional main branch stenting, with the advantage of an optimal ostial side branch coverage without the disadvantage of an excessive amount of metal in the main branch. Medina 0,0,1 lesions are relatively rare and there is no consensus on treatment strategy. Several previous techniques have been described, all with considerable disadvantages. Between October 2009 and November 2011, 12 patients with Medina 0,0,1 lesions treated with Tryton alone were included. Clinical outcomes were reported as all-cause mortality, recurrent myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), and target vessel failure (TVF; defined as the composite of all-cause mortality, MI, and TVR). Procedural success was defined as successful stent placement with residual stenosis

Published
2013

28. Current status of drug-eluting stents and drug-eluting balloons in patients with stable coronary artery disease : an expert consensus document of the Association for Percutaneous Cardiovascular Interventions and Polish Cardiac Society

Author

Witkowski, Adam, Opolski, Maksymilian P., Dudek, Dariusz, Lesiak, Maciej, Legutko, Jacek, Wojakowski, Wojciech, Ochała, Andrzej, Maciejewski, Paweł, Deptuch, Tomasz, Araszkiewicz, Aleksander, and Ciećwierz, Dariusz

Subjects
drug eluting stents, randomised clinical trials, stenty uwalniające leki antyproliferacyjne, balony uwalniające leki antyproliferacyjne, randomizowane badania kliniczne, drug eluting balloons
Abstract

Mimo istotnego postępu w zmniejszeniu częstości restenozy i ponownych zabiegów rewaskularyzacyjnych przez stenty uwalniające leki antyproliferacyjne (DES, drug eluting stents) istnieją sprzeczne dane dotyczące podwyższonego ryzyka występowania późnej zakrzepicy w DES w porównaniu ze stentami metalowymi. Z pewnością wynika to z różnej skuteczności i bezpieczeństwa poszczególnych rodzajów DES, których liczba systematycznie się zwiększa. Ponadto ostatnio obserwuje się stopniowe zwiększenie dostępności DES, które nie osiągnęły pierwszorzędowych punktów końcowych w badaniach randomizowanych. Z tego powodu w przypadku DES nie można mówić o efekcie klasy. Niniejsze stanowisko stanowi analizę 110 randomizowanych badań klinicznych poświęconych DES, przeprowadzonych wśród 72 305 chorych. Cele niniejszego opracowania to usystematyzowanie wiedzy o DES oraz ocena wskazań do ich implantacji w rożnych sytuacjach klinicznych. Despite a dramatic reduction in restenosis and target vessel revascularisation rates by drug eluting stents (DES), conflicting concerns have been raised over the risk for late DES thrombosis when compared to bare metal stents. Certainly, the heterogeneity of DES results from the introduction of a great variety of new DES types with diverse efficacy and safety parameters. Furthemore, we observe a steady increase in DES availability without parallel and robust data from randomised clinical trials. Thus, the postulated class effect of DES should be regarded as nonobligatory. This article is based on 110 randomised DES trials performed on 72 305 patients. Current status of DES and guidelines for DES implantation in various clinical scenarios were discussed.

Published
2011

30. Current status of drug-eluting stents and drug-eluting balloons in patients with stable coronary artery disease : an expert consensus document of the Association for Percutaneous Cardiovascular Interventions and the Polish Cardiac Societ

Author

Witkowski, Adam, Opolski, Maksymilian P., Dudek, Dariusz, Lesiak, Maciej, Legutko, Jacek, Wojakowski, Wojciech, Ochała, Andrzej, Maciejewski, Paweł, Deptuch, Tomasz, Araszkiewicz, Aleksander, Ciećwierz, Dariusz, Gil, Robert, Grajek, Stefan, and Poloński8, Lech

Subjects
randomized clinical trials, badania kliniczne z randomizacją, stenty uwalniające leki antyproliferacyjne, balony uwalniające leki antyproliferacyjne, drug-eluting balloons, drug-eluting stents
Abstract

Pomimo istotnego zmniejszania częstości restenozy i ponownych zabiegów rewaskularyzacyjnych przez stenty uwalniające leki antyproliferacyjne (ang. drug eluting stents – DES), istnieją sprzeczne dane na temat podwyższonego ryzyka występowania późnej zakrzepicy w DES w porównaniu ze stentami metalowymi (ang. bare metal stent – BMS). Z pewnością wynika to z różnej skuteczności i bezpieczeństwa poszczególnych rodzajów DES, których liczba systematycznie się zwiększa. Ponadto w ostatnim okresie obserwujemy stopniowe zwiększenie dostępności DES, które nie osiągnęły pierwszorzędowych punktów końcowych w badaniach z randomizacją. Z tego powodu w przypadku DES nie można mówić o efekcie klasy. Niniejszy dokument stanowi analizę 110 badań klinicznych z randomizacją poświęconych DES, obejmujących 72 305 chorych. Celem niniejszego stanowiska jest usystematyzowanie wiedzy o DES oraz ocena wskazań do ich implantacji w różnych sytuacjach klinicznych. Despite a dramatic reduction in restenosis and target vessel revascularization rates by drug-eluting stents (DES), conflicting concerns have been raised over the risk of late DES thrombosis when compared to bare-metal stents. Certainly, the heterogeneity of DES results from the introduction of a great variety of new DES types with diverse efficacy and safety parameters. Furthermore, there is a steady increase in DES availability without parallel and robust data from randomized clinical trials. Thus, the postulated class effect of DES should be regarded as non-obligatory. This article is based on 110 randomized DES trials performed on 72 305 patients. Current status of DES and guidelines for DES implantation in various clinical scenarios are discussed.

Published
2011

31. Invasive treatment strategies in patients with myocardial infarction in Poland

Author

Dudek, Dariusz, Legutko, Jacek, Siudak, Zbigniew, Rakowski, Tomasz, Dziewierz, Artur, Bartuś, Stanisław, Rzeszutko, Łukasz, Grajek, Stefan, Witkowski, Adam, Lesiak, Maciej, Dubiel, Jacek, Żmudka, Krzysztof, Sadowski, Jerzy, Kracik, Stanisław, Mawlichanów, Krzysztof, and Opolski, Grzegorz

Published
2010

32. Expert panel position statement on imaging diagnostics and indications for percutaneous angioplasty for renal artery stenosis in hypertensive patients, adopted by Polish Society of Hypertension and Polish Society of Nephrology

Author

Andziak, Piotr, Buszman, Paweł, Cieszanowski, Andrzej, Czekalski, Stanisław, Gaciong, Zbigniew, Gil, Robert, Głuszek, Jerzy, Januszewicz, Andrzej, Januszewicz, Magdalena, Januszewicz, Włodzimierz, Juszkat, Robert, Kabat, Marek, Kabłak-Ziembicka, Anna, Kądziela, Jacek, Kleinork, Andrzej, Lekston, Andrzej, Lesiak, Maciej, Michałowska, Ilona, Posadzy-Małaczyńska, Anna, Prejbisz, Aleksandra, Przewłocki, Tadeusz, Rowiński, Olgierd, Rynkiewicz, Andrzej, Szczerbo-Trojanowska, Małgorzata, Tykarski, Andrzej, Więcek, Andrzej, and Witkowski, Adam

Published
2009

34. Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk

Author

Valgimigli, M., Frigoli, E., Heg, D., Tijssen, Jan, Jüni, Peter, Vranckx, Pascal, Ozaki, Yukio, Morice, Marie-Claude, Chevalier, Bernard, Onuma, Yoshinobu, Windecker, S., Tonino, Pim A L, Roffi, Marco, Lesiak, Maciej, Mahfoud, Felix, Bartunek, Jozef, Hildick-Smith, David, Colombo, Antonio, Stanković, Goran, Iñiguez, Andrés, Schultz, Carl, Kornowski, Ran, Ong, Paul J L, Alasnag, Mirvat, Rodriguez, Alfredo E, Moschovitis, Aris, Laanmets, Peep, Donahue, Michael, Leonardi, Sergio, and Smits, Pieter C

Subjects
610 Medicine & health, 3. Good health
Abstract

BACKGROUND The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. METHODS One month after they had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent, we randomly assigned patients at high bleeding risk to discontinue dual antiplatelet therapy immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy). The three ranked primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding; cumulative incidences were assessed at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population. RESULTS Among the 4434 patients in the per-protocol population, net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and in 172 (7.7%) in the standard-therapy group (difference, -0.23 percentage points; 95% confidence interval [CI], -1.80 to 1.33; P

35. Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label, Randomized, Controlled Trial

Author

Smits, Pieter C, Frigoli, Enrico, Tijssen, Jan, Jüni, Peter, Vranckx, Pascal, Ozaki, Yukio, Morice, Marie-Claude, Chevalier, Bernard, Onuma, Yoshinobu, Windecker, Stephan, Tonino, Pim A L, Roffi, Marco, Lesiak, Maciej, Mahfoud, Felix, Bartunek, Jozef, Hildick-Smith, David, Colombo, Antonio, Stankovic, Goran, Iñiguez, Andres, Schultz, Carl, Kornowski, Ran, Ong, Paul J L, Alasnag, Mirvat, Rodriguez, Alfredo E, Moschovitis, Aris, Laanmets, Peep, Heg, Dik, and Valgimigli, Marco

Subjects
610 Medicine & health, 3. Good health
Abstract

Background: The optimal duration of antiplatelet therapy (APT) in patients at high bleeding risk with or without oral anticoagulation (OAC) after coronary stenting remains unclear. Methods: In the investigator-initiated, randomized, open-label MASTER DAPT trial, 4579 patients at high bleeding risk were randomized after 1-month dual APT (DAPT) to abbreviated or nonabbreviated APT strategies. Randomization was stratified by concomitant OAC indication. In this subgroup analysis we report outcomes of populations with or without an OAC indication. In the population with an indication, patients changed immediately to single APT (SAPT) for 5 months (abbreviated regimen) or continued ≥ 2 months DAPT and SAPT thereafter (nonabbreviated regimen). Patients without an OAC indication changed to SAPT for 11 months (abbreviated regimen) or continued ≥5 months of DAPT and SAPT thereafter (nonabbreviated regimen). Coprimary outcomes at 335 days after randomization were: net adverse clinical outcomes (NACE; composite of all-cause death, myocardial infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac and cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5 BARC bleeding. Results: NACE or MACE did not differ with abbreviated versus nonabbreviated APT regimens in patients with OAC indication (n=1666; HR, 0.83; 95% CI, 0.60 to 1.15, HR, 0.88; 95% CI, 0.60 to 1.30; respectively) or without OAC indication (n=2913; HR, 1.01; 95% CI, 0.77 to 1.33; HR, 1.06; 95% CI, 0.79 to 1.44; Pinteraction=0.35 and 0.45, respectively). BARC 2, 3 or 5 bleeding did not significantly differ in patients with OAC indication (HR, 0.83; 95% CI, 0.62 to 1.12) but was lower with abbreviated APT in patients without OAC indication (HR, 0.55; 95% CI, 0.41 to 0.74; Pinteraction=0.057). The difference in bleeding in patients without OAC indication was driven mainly by a reduction in BARC 2 bleedings (HR, 0.48; 95% CI 0.33 to 0.69; Pinteraction=0.021). Conclusions: Rates of NACE and MACCE did not differ with abbreviated APT in high bleeding risk patients with or without an OAC indication and resulted in lower bleeding rates in patients without an OAC indication. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier:NCT03023020.

38. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author

Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits

Subjects
Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Published
2020

39. Design and rationale of the Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen (MASTER DAPT) Study

Author

Aris Moschovitis, Alfredo E. Rodriguez, Felix Mahfoud, Maciej Lesiak, Marco Valgimigli, Ran Kornowski, Carl Schultz, Sergio Leonardi, Peter Jüni, Stefan James, Yoshinobu Onuma, Dik Heg, Mikael Sunnåker, Pim A.L. Tonino, Mirvat Alasnag, Christian Spaulding, Andre Frenk, Marie-Claude Morice, Andrés Iñiguez, David Hildick-Smith, Stephan Windecker, Pieter C. Smits, Bernard Chevalier, Enrico Frigoli, Marco Roffi, Paul Jau Lueng Ong, Yokio Ozaki, Goran Stankovic, Antonio Colombo, Emanuele Barbato, Pascal Vranckx, Ajit S. Mullasari, Jozef Bartunek, Jan G.P. Tijssen, Peep Laanmets, Frigoli, Enrico, Smits, Pieter, Vranckx, Pascal, Ozaki, Yokio, Tijssen, Jan, Jüni, Peter, Morice, Marie-Claude, Onuma, Yoshinobu, Windecker, Stephan, Frenk, Andrè, Spaulding, Christian, Chevalier, Bernard, Barbato, Emanuele, Tonino, Pim, Hildick-Smith, David, Roffi, Marco, Kornowski, Ran, Schultz, Carl, Lesiak, Maciej, Iñiguez, André, Colombo, Antonio, Alasnag, Mirvat, Mullasari, Ajit, James, Stefan, Stankovic, Goran, Ong, Paul J L, Rodriguez, Alfredo E, Mahfoud, Felix, Bartunek, Jozef, Moschovitis, Ari, Laanmets, Peep, Leonardi, Sergio, Heg, Dik, Sunnåker, Mikael, and Valgimigli, Marco

Subjects
Male, medicine.medical_specialty, Polymers, Bioresorbable polymers, 610 Medicine & health, Coronary Artery Disease, 030204 cardiovascular system & hematology, Postoperative Hemorrhage, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, Absorbable Implants, medicine, Therapy duration, Stent implantation, Humans, Cardiac and Cardiovascular Systems, 030212 general & internal medicine, cardiovascular diseases, Aged, 80 and over, Sirolimus, Kardiologi, Interventional cardiology, business.industry, Dual Anti-Platelet Therapy, Drug-Eluting Stents, medicine.disease, 3. Good health, Surgery, Regimen, Concomitant, Female, Cardiology and Cardiovascular Medicine, business, Immunosuppressive Agents
Abstract

BACKGROUND: The optimal duration of antiplatelet therapy in high-bleeding risk (HBR) patients with coronary artery disease treated with newer-generation drug-eluting bioresorbable polymer-coated stents remains unclear. DESIGN: MASTER DAPT (clinicaltrial.govNCT03023020) is an investigator-initiated, open-label, multicenter, randomized controlled trial comparing an abbreviated versus a standard duration of antiplatelet therapy after bioresorbable polymer-coated Ultimaster (TANSEI) sirolimus-eluting stent implantation in approximately 4,300 HBR patients recruited from ≥100 interventional cardiology centers globally. After a mandatory 30-day dual-antiplatelet therapy (DAPT) run-in phase, patients are randomized to (a) a single antiplatelet regimen until study completion or up to 5 months in patients with clinically indicated oral anticoagulation (experimental 1-month DAPT group) or (b) continue DAPT for at least 5 months in patients without or 2 in patients with concomitant indication to oral anticoagulation, followed by a single antiplatelet regimen (standard antiplatelet regimen). With a final sample size of 4,300 patients, this study is powered to assess the noninferiority of the abbreviated antiplatelet regimen with respect to the net adverse clinical and major adverse cardiac and cerebral events composite end points and if satisfied for the superiority of abbreviated as compared to standard antiplatelet therapy duration in terms of major or clinically relevant nonmajor bleeding. Study end points will be adjudicated by a blinded Clinical Events Committee. CONCLUSIONS: The MASTER DAPT study is the first randomized controlled trial aiming at ascertaining the optimal duration of antiplatelet therapy in HBR patients treated with sirolimus-eluting bioresorbable polymer-coated stent implantation. ispartof: AMERICAN HEART JOURNAL vol:209 pages:97-105 ispartof: location:United States status: published

Published
2019

40. Bioresorbable Everolimus-Eluting Vascular Scaffold for Long Coronary Lesions: A Subanalysis of the International, Multicenter GHOST-EUÂ Registry

Author

Salvatore, Geraci, Hiroyoshi, Kawamoto, Giuseppe, Caramanno, Neil, Ruparelia, Davide, Capodanno, Salvatore, Brugaletta, Tommaso, Gori, Holger, Nef, Manel, Sabate, Julinda, Mehilli, Maciej, Lesiak, Christoph, Naber, Carlo, Di Mario, Piera, Capranzano, Jens, Wiebe, Aleksander, Araszkiewicz, Stelios, Pyxaras, Alessio, Mattesini, Thomas, Münzel, Corrado, Tamburino, Antonio, Colombo, Azeem, Latib, Geraci, Salvatore, Kawamoto, Hiroyoshi, Caramanno, Giuseppe, Ruparelia, Neil, Capodanno, Davide, Brugaletta, Salvatore, Gori, Tommaso, Nef, Holger, Sabate, Manel, Mehilli, Julinda, Lesiak, Maciej, Naber, Christoph, Di Mario, Carlo, Capranzano, Piera, Wiebe, Jen, Araszkiewicz, Aleksander, Pyxaras, Stelio, Mattesini, Alessio, Mã¼nzel, Thoma, Tamburino, Corrado, Colombo, Antonio, and Latib, Azeem

Subjects
Male, Registrie, Time Factors, Coronary Thrombosi, Time Factor, Myocardial Infarction, Coronary Artery Disease, Kaplan-Meier Estimate, Coronary Angiography, Prosthesis Design, Percutaneous Coronary Intervention, Coated Materials, Biocompatible, Risk Factors, vascular reparative therapy, Retrospective Studie, Absorbable Implant, Absorbable Implants, Humans, Everolimus, Registries, Proportional Hazards Models, Retrospective Studies, Aged, Coronary Thrombosis, Risk Factor, Cardiovascular Agents, Middle Aged, Europe, Everolimu, long coronary lesion, Treatment Outcome, Cardiovascular Agent, complex coronary lesion, Proportional Hazards Model, bioresorbable vascular scaffold, Female, Cardiology and Cardiovascular Medicine, Human
Abstract

Objectives The authors sought to investigate 1-year outcomes in patients treated with bioresorbable everolimus-eluting vascular scaffolds (BVS) for “long coronary lesions.” Background The present substudy derived from the GHOST-EU registry included 1,722 lesions in 1,468 consecutive patients, enrolled between November 2011 and September 2014 at 11 European centers. Methods The lesions were divided into 3 groups according to continuous BVS length: 1) shorter than 30 mm; 2) between 30 and 60 mm; and 3) longer than 60 mm. Primary device-oriented endpoint (target lesion failure [TLF]) was defined as a combination of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Results Patients with lesions ≥60 mm had more comorbidities and more complex lesion characteristics, including chronic total occlusions (37%), bifurcation lesions (40.3%), higher Syntax score (16.4 ± 7.8), and higher number of scaffolds implanted per lesion (3.3 ± 0.9 mm). The main target vessel was the left anterior coronary artery in all groups. Median follow-up was 384 (interquartile range: 359 to 459) days. One-year follow-up was completed in 70.3% of patients. TLF at 1 year was significantly higher in group C (group A 4.8%, group B 4.5%, group C 14.3%; overall p = 0.001), whereas there were no significant differences between groups A and B. Finally, a numerically higher (but not statistically significant) number of scaffold thromboses were observed in group C when compared with shorter lesions (group A 2.1%, group B 1.1%, group C 3.8%; overall p = 0.29). Conclusions In a real-world setting, treatment of long coronary lesions with BVS ≥60 mm was associated with a higher TLF rate, driven by myocardial infarction and clinically driven target lesion revascularization.

Published
2017

41. Predilation, sizing and post-dilation scoring in patients undergoing everolimus-eluting bioresorbable scaffold implantation for prediction of cardiac adverse events: Development and internal validation of the PSP score

Author

Stelios Pyxaras, Thomas Münzel, Toru Naganuma, Salvatore Geraci, Salvatore Brugaletta, Piera Capranzano, Corrado Tamburino, Maciej Lesiak, Jens Wiebe, Carlo Di Mario, Manel Sabaté, Holger Nef, Julinda Mehilli, Antonio Colombo, Giuseppe Caramanno, Tommaso Gori, Azeem Latib, Davide Capodanno, Alessio Mattesini, Christoph Naber, Luis Ortega-Paz, Aleksander Araszkiewicz, Ortega paz, Lui, Capodanno, Davide, Gori, Tommaso, Nef, Holger, Latib, Azeem, Caramanno, Giuseppe, Di Mario, Carlo, Naber, Christoph, Lesiak, Maciej, Capranzano, Piera, Wiebe, Jen, Mehilli, Julinda, Araszkiewicz, Aleksander, Pyxaras, Stelio, Mattesini, Alessio, Geraci, Salvatore, Naganuma, Toru, Colombo, Antonio, Mã¼nzel, Thoma, Sabatã©, Manel, Tamburino, Corrado, and Brugaletta, Salvatore

Subjects
Target lesion, Bioresorbable scaffold, medicine.medical_specialty, Antineoplastic Agents, 030204 cardiovascular system & hematology, Risk Assessment, Clinical research, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Outcome Assessment (Health Care), 0302 clinical medicine, Postoperative Complications, Theoretical, Blood vessel prosthesis, Models, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Everolimus, Adverse effect, Prospective cohort study, Bioresorbable scaffolds, Risk stratification, Blood Vessel Prosthesis, Retrospective Studies, Tissue Scaffolds, Models, Theoretical, Cardiology and Cardiovascular Medicine, business.industry, Retrospective cohort study, medicine.disease, Thrombosis, Surgery, Cardiology, business, medicine.drug
Abstract

Aims: The aim of the study was to develop a scoring model to evaluate the quality of bioresorbable vascular scaffold (BVS) implantation and determine the model's usefulness in predicting adverse cardiac events. Methods and results: The implantation technique and clinical outcomes of 1,736 lesions treated with BVS were analysed using the GHOST-EU registry. Predilation, scaffold sizing, and post-dilation (PSP) were scored according to the hazard model derived from the weight of these variables. The primary end-point was a one-year device-oriented composite endpoint (DoCE) composed of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularisation. Definite/probable scaffold thrombosis was also evaluated as defined by the Academic Research Consortium. The PSP model performance was evaluated by internal validation. Predilation, correct scaffold sizing, and post-dilation with a non-compliant balloon were performed in 95.7%, 50.2%, and 26.2% of the cases and scored 0.63, 1.96 and 1.93 points, respectively, in the PSP-1 model. PSP-1 was an independent predictor of one-year DoCE (HR 0.75, 95% CI: 0.61-0.93; p=0.007), but with poor calibration and discrimination (AUC 0.611, 95% CI: 0.545-0.677). No patient with a maximum PSP-1 score had scaffold thrombosis, compared to those with a non-maximum PSP-1 score (0% vs. 2.3%; p=0.095). Conclusions: At one-year follow-up, the PSP-1 score was an independent predictor of DoCE. External validation and prospective studies are needed to determine the clinical usefulness of this score.

Published
2017

42. Impact of overlapping on 1-year clinical outcomes in patients undergoing everolimus-eluting bioresorbable scaffolds implantation in routine clinical practice: Insights from the European multicenter GHOST-EU registry

Author

ORTEGA PAZ, L, Capodanno, DAVIDE FRANCESCO MARIA, Giacchi, G, Gori, T, Nef, H, Latib, A, Caramanno, G, DI MARIO, C, Naber, C, Lesiak, M, Capranzano, P, Wiebe, J, Mehilli, J, Araszkiewicz, A, Pyxaras, S, Mattesini, A, Geraci, S, Colombo, A, Naganuma, Munzel, T, Sabate, M, Tamburino, Corrado, Brugaletta, S., Ortega paz, Lui, Capodanno, Davide, Giacchi, Giuseppe, Gori, Tommaso, Nef, Holger, Latib, Azeem, Caramanno, Giuseppe, Di Mario, Carlo, Naber, Christoph, Lesiak, Maciej, Capranzano, Piera, Wiebe, Jen, Mehilli, Julinda, Araszkiewicz, Aleksander, Pyxaras, Stelio, Mattesini, Alessio, Geraci, Salvatore, Naganuma, Toru, Colombo, Antonio, Mã¼nzel, Thoma, Sabatã©, Manel, Tamburino, Corrado, and Brugaletta, Salvatore

Subjects
Registrie, Male, Radiology, Nuclear Medicine and Imaging, Time Factors, Time Factor, Coronary Artery Disease, Prosthesis Design, Follow-Up Studie, Immunosuppressive Agent, Percutaneous Coronary Intervention, Postoperative Complications, Tissue Scaffold, Retrospective Studie, Absorbable Implant, Absorbable Implants, Drug-Eluting Stent, Humans, Everolimus, Registries, Retrospective Studies, Overlapping implantation of bioresorbable scaffolds (BRSs) are frequent in long coronary lesions. Its impact on clinical outcomes is unknown, Tissue Scaffolds, Incidence, Drug-Eluting Stents, bioresorbable scaffold, Middle Aged, Europe, Survival Rate, Everolimu, bioresorbable vascular scaffold, Female, Postoperative Complication, Cardiology and Cardiovascular Medicine, Immunosuppressive Agents, Human, Follow-Up Studies
Abstract

Background: Overlapping implantation of bioresorbable scaffolds (BRSs) are frequent in long coronary lesions. Its impact on clinical outcomes is unknown. Objective: To compare the clinical outcomes of patients treated with overlapping BRS with those patients treated with no-overlap BRS. Methods: We analyzed the 1-year clinical outcomes of 1,477 patients treated with BRS in the GHOST-EU registry, according to the implantation of overlapping BRS. Primary endpoint was patient oriented composite endpoint (PoCE) of: all-cause death, any myocardial infarction (MI) and any repeated revascularization. Scaffold thrombosis, according to Academic Research Consortium definition, was also analyzed. Results: A total of 320 (21.7%) patients were treated with overlapping BRS (overlap group), whereas the remaining 1,157 (78.3%) received no-overlap BRS (no-overlap group). The overlap group had significantly higher frequency of male sex, diabetes mellitus, stable angina, B2/C lesion type, SYNTAX score ≥22, lesion length >34 mm, use of intracoronary imaging guidance, pre- and postdilatation. At 1-year, there were no differences in PoCE between the overlap versus no-overlap group (18.4% vs. 18.2%; HR 1.07, [0.80–1.44]; P = 0.636), even after adjustment (HR 1.05, [0.48–2.20]; P = 0.904). Scaffold thrombosis rate did not differ either at one-month (1.3% vs. 1.5%, P = 0.769) or at 1-year (1.9% vs. 2.1%, P = 0.823). Conclusions: In “Real-world” clinical practice, overlapping BRS does not appear to have an impact on clinical outcomes as compared to no-overlapping BRS. These preliminary data should be confirmed. © 2016 Wiley Periodicals, Inc.

Published
2016

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