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2. Evaluation and Management of Nonculprit Lesions in STEMI

Author

Thim, T., Hoeven, N.W. Van Der, Musto, C., Nijveldt, R., Gotberg, M., Engstrom, T., Smits, P.C., Oldroyd, K.G., Gershlick, A.H., Escaned, J., Baptista, S.B., Raposo, L., Royen, N. van, Maeng, M., Thim, T., Hoeven, N.W. Van Der, Musto, C., Nijveldt, R., Gotberg, M., Engstrom, T., Smits, P.C., Oldroyd, K.G., Gershlick, A.H., Escaned, J., Baptista, S.B., Raposo, L., Royen, N. van, and Maeng, M.

Abstract

Contains fulltext : 220912.pdf (Publisher’s version ) (Closed access), Nonculprit lesions are frequently observed in patients with ST-segment elevation myocardial infarction. Results from recent randomized clinical trials suggest that complete revascularization after ST-segment elevation myocardial infarction improves outcomes. In this state-of-the-art paper, the authors review these trials and consider how best to determine which nonculprit lesions require revascularization and when this should be performed.

Published
2020

3. Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance : a report from SCAAR

Author

Volz, S., Redfors, B., Dworeck, C., Petursson, P., Gotberg, M., Jernberg, T., Linder, R., Ramunddal, T., Fröbert, Ole, Witt, N., James, S., Erlinge, D., Omerovic, E., Volz, S., Redfors, B., Dworeck, C., Petursson, P., Gotberg, M., Jernberg, T., Linder, R., Ramunddal, T., Fröbert, Ole, Witt, N., James, S., Erlinge, D., and Omerovic, E.

Abstract

Background: Intracoronary pressure wire measurements of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) provide decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the impact of FFR/iFR on long-term clinical outcomes in patients with stable angina, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), or STEMI. Methods: We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) on all patients in Sweden undergoing PCI (with or without FFR/iFR guidance) for stable angina, UA/NSTEMI, or STEMI between January 2005 and March 2018. The primary endpoint was all-cause mortality and the secondary endpoints were stent thrombosis or restenosis and periprocedural complications. The primary model was multilevel Cox proportional-hazards regression using an instrumental variable (IV) to adjust for known and unknown confounders with treating hospital as a treatment-preference instrument. The following variables were entered into Cox proportional-hazards regression in addition to the IV: age, sex, diabetes, indication for PCI, severity of coronary disease, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, previous PCI, previous coronary artery bypass graft, type of stent. Results: In total, 151,001 patients underwent PCI: 31,514 (20.9%) for stable angina, 74,982 (49.6%) for UA/NSTEMI, and 44,505 (29.5%) for STEMI. Of these, FFR/iFR guidance was used in 11,433 patients (7.6%): 5029 (44.0%) with stable angina, 5989 (52.4%) with UA/NSTEMI, and 415 (3.6%) with STEMI; iFR was used in 1156 (10.1%) of these patients. After a median follow-up of 1784 (range 1–4824) days, the FFR/iFR group had lower adjusted risk estimates for all-cause mortality [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69–0.91; P=0.001] and stent thrombosis and restenosis (HR 0.13; 95% CI 0.09–0.19; P<0.001). The number of periprocedural complications did, Funding Agency:ALF Västra Götaland

Published
2020
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4. Utilization and outcomes of rotational atherectomy in Sweden

Author

Venetsanos, D., Erlinge, D., Omerovic, E., Calais, Fredrik, Angeras, O., Jensen, J., Henareh, L., Todt, T., Gotberg, M., Sarno, G., Aasa, M., Lagerqvist, B., James, S., Alfredsson, J., Venetsanos, D., Erlinge, D., Omerovic, E., Calais, Fredrik, Angeras, O., Jensen, J., Henareh, L., Todt, T., Gotberg, M., Sarno, G., Aasa, M., Lagerqvist, B., James, S., and Alfredsson, J.

Abstract

Aim: To evaluate utilization and outcomes of rotational atherectomy (RA) using data from the Swedish Coronary and Angioplasty Registry (SCAAR). Methods: We included 1476 patients with 2218 lesions who underwent RA from 2005 to 2016. To study temporal changes, the study period was divided into three equal time-periods, period A, B and C. Results: Although the number of RA procedures increased 3-fold from 2005 to 2016, the rate of RA (of all PCI procedures) remained low (0.5% vs 1.2% in 2005 vs 2016). RA patients consisted a high-risk group, with advanced age and clustering of comorbidities. Over time, included patients were older and had a higher risk profile. Trans-radial access, drug eluting stent (DES) use and use of intravascular imaging significantly increased from period A to C whereas positioning of a temporary pacemaker or intra-aortic balloon pump declined. Unfractionated heparin became the main anticoagulant (52 vs 87%) and use of glycoprotein IIb/IIIa inhibitors declined (31 vs 12%, in period A vs C). Following RA, 11% of lesions were treated without stent (15 vs 15 vs 8%, in period A, B and C) (Rota-only). In lesions treated with a stent, a bare metal stent (BMS) was implanted in 39% vs 12% vs 2% and a new generation DES (N-DES) in 5 vs 75 vs 97% (period A vs B vs C) of lesions. The 3-year cumulative rate of restenosis was 6.7% (122 events), (11.1 vs 7.1 vs 4.1% in period A vs B vs C). As compared to DES, rota-only (adjusted HR 2.71; 95% CI 1.69- 4.36) and BMS (adjusted HR 3.63; 95% CI 2.27- 5.81) were associated with significantly higher risk for restenosis. First generation DES were associated with numerically higher but not significantly different risk for restenosis as compared to N-DES (adjusted HR 1.31; 95% CI 0.74- 2.31). The 3 year cumulative rate of major adverse cardiac events (MACE), including death, myocardial infarction (MI) or any restenosis was 30.6% (34.2 vs 31.4 vs 28.2%, in period A vs B vs C) and the corresponding numbers for all-cause

Published
2020
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5. Utilization and outcomes of rotational atherectomy in Sweden

Author

Venetsanos, D, primary, Erlinge, D, additional, Omerovic, E, additional, Calais, F, additional, Angeras, O, additional, Jensen, J, additional, Henareh, L, additional, Todt, T, additional, Gotberg, M, additional, Sarno, G, additional, Aasa, M, additional, Lagerqvist, B, additional, James, S, additional, and Alfredsson, J, additional

Published
2020
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6. Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance: a report from SCAAR

Author

Volz, S, primary, Redfors, B, additional, Dworeck, C, additional, Petursson, P, additional, Gotberg, M, additional, Jernberg, T, additional, Linder, R, additional, Ramunddal, T, additional, Frobert, O, additional, Witt, N, additional, James, S, additional, Erlinge, D, additional, and Omerovic, E, additional

Published
2020
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7. Artificial Intelligence for Aortic Pressure Waveform Analysis During Coronary Angiography: Machine Learning for Patient Safety

Author

Howard, J.P., Cook, C.M., Hoef, T.P. van de, Meuwissen, M., Waard, G.A. de, Lavieren, M.A. van, Echavarria-Pinto, M., Danad, I., Piek, J.J., Gotberg, M., Al-Lamee, R.K., Sen, S., Nijjer, S.S., Seligman, H., Royen, N. van, Knaapen, P., Escaned, J., Francis, D.P., Petraco, R., and Davies, J.E.

Subjects
Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16]
Abstract

Item does not contain fulltext OBJECTIVES: This study developed a neural network to perform automated pressure waveform analysis and allow real-time accurate identification of damping. BACKGROUND: Damping of aortic pressure during coronary angiography must be identified to avoid serious complications and make accurate coronary physiology measurements. There are currently no automated methods to do this, and so identification of damping requires constant monitoring, which is prone to human error. METHODS: The neural network was trained and tested versus core laboratory expert opinions derived from 2 separate datasets. A total of 5,709 aortic pressure waveforms of individual heart beats were extracted and classified. The study developed a recurrent convolutional neural network to classify beats as either normal, showing damping, or artifactual. Accuracies were reported using the opinions of 2 independent core laboratories. RESULTS: The neural network was 99.4% accurate (95% confidence interval: 98.8% to 99.6%) at classifying beats from the testing dataset when judged against the opinions of the internal core laboratory. It was 98.7% accurate (95% confidence interval: 98.0% to 99.2%) when judged against the opinions of an external core laboratory not involved in neural network training. The neural network was 100% sensitive, with no beats classified as damped misclassified, with a specificity of 99.8%. The positive predictive and negative predictive values were 98.1% and 99.5%. The 2 core laboratories agreed more closely with the neural network than with each other. CONCLUSIONS: Arterial waveform analysis using neural networks allows rapid and accurate identification of damping. This demonstrates how machine learning can assist with patient safety and the quality control of procedures.

Published
2019

8. Sex-related response to bivalirudin and unfractionated heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention : A subgroup analysis of the VALIDATE-SWEDEHEART trial

Author

Venetsanos, D., Lawesson, S. Sederholm, Frobert, O., Omerovic, E., Henareh, L., Robertsson, L., Linder, R., Gotberg, M., James, Stefan, Alfredsson, J., Erlinge, D., Swahn, E., Venetsanos, D., Lawesson, S. Sederholm, Frobert, O., Omerovic, E., Henareh, L., Robertsson, L., Linder, R., Gotberg, M., James, Stefan, Alfredsson, J., Erlinge, D., and Swahn, E.

Abstract

Aims: Our aim was to study the impact of sex on anticoagulant treatment outcomes during percutaneous coronary intervention in acute myocardial infarction patients. Methods: This study was a prespecified analysis of the Bivalirudin versus Heparin in ST-Segment and Non ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which patients with myocardial infarction were randomised to bivalirudin or unfractionated heparin during percutaneous coronary intervention. The primary outcome was the composite of death, myocardial infarction or major bleeding at 180 days. Results: There was a lower risk of the primary outcome in women assigned to bivalirudin than to unfractionated heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval (0.60-1.00)) with no significant difference in men (11.8% vs 11.2%, hazard ratio 1.06 (0.89-1.26), p for interaction 0.05). The observed difference was primarily due to lower risk of major bleeding (Bleeding Academic Research Consortium definition 2, 3 or 5) associated with bivalirudin in women (8.9% vs 11.8%, hazard ratio 0.74 (0.54-1.01)) but not in men (8.5% vs 7.3%, hazard ratio 1.16 (0.94-1.43) in men, p for interaction 0.02). Conversely, no significant difference in the risk of Bleeding Academic Research Consortium 3 or 5 bleeding, associated with bivalirudin, was found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54-1.31)) or men 2.9% vs 2.1% (hazard ratio 1.36 (0.93-1.99)). Bleeding Academic Research Consortium 2 bleeding occurred significantly less often in women assigned to bivalirudin than to unfractionated heparin. The risk of death or myocardial infarction did not significantly differ between randomised treatments in men or women. Conclusion: In women, bivalirudin was associated with a lower risk of adverse

Published
2019
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9. Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow

Author

Ahmad, Y., Vendrik, J., Eftekhari, A., Howard, J.P., Cook, C., Rajkumar, C., Malik, I., Mikhail, G., Ruparelia, N., Hadjiloizou, N., Nijjer, S., Al-Lamee, R., Petraco, R., Warisawa, T., Wijntjens, G.W., Koch, K.T., Hoef, T. van de, Waard, G. de, Echavarria-Pinto, M., Frame, A., Sutaria, N., Kanaganayagam, G., Ariff, B., Anderson, J., Chukwuemeka, A., Fertleman, M., Koul, S., Iglesias, J.F., Francis, D., Mayet, J., Serruys, P., Davies, J., Escaned, J., Royen, N. van, Gotberg, M., Terkelsen, C. Juhl, Christiansen, E., Piek, J.J., Baan, J., Jr., Sen, S., Ahmad, Y., Vendrik, J., Eftekhari, A., Howard, J.P., Cook, C., Rajkumar, C., Malik, I., Mikhail, G., Ruparelia, N., Hadjiloizou, N., Nijjer, S., Al-Lamee, R., Petraco, R., Warisawa, T., Wijntjens, G.W., Koch, K.T., Hoef, T. van de, Waard, G. de, Echavarria-Pinto, M., Frame, A., Sutaria, N., Kanaganayagam, G., Ariff, B., Anderson, J., Chukwuemeka, A., Fertleman, M., Koul, S., Iglesias, J.F., Francis, D., Mayet, J., Serruys, P., Davies, J., Escaned, J., Royen, N. van, Gotberg, M., Terkelsen, C. Juhl, Christiansen, E., Piek, J.J., Baan, J., Jr., and Sen, S.

Abstract

Contains fulltext : 215204.pdf (publisher's version ) (Open Access), BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71+/-1.4 mm Hg.cm.s(-1) versus post-TAVI 3.04+/-1.6 mm Hg.cm.s(-1) [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88+/-1.0 versus post-TAVI 2.09+/-0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of

Published
2019

10. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author

Escaned, J., Ryan, N., Mejia-Renteria, H., Cook, C.M., Dehbi, H.M., Alegria-Barrero, E., Alghamdi, A., Al-Lamee, R., Altman, J., Ambrosia, A., Baptista, S.B., Bertilsson, M., Bhindi, R., Birgander, M., Bojara, W., Brugaletta, S., Buller, C., Calais, F., Silva, P.C., Carlsson, J., Christiansen, E.H., Danielewicz, M., Mario, C. de, Doh, J.H., Erglis, A., Erlinge, D., Gerber, R.T., Going, O., Gudmundsdottir, I., Harle, T., Hauer, D., Hellig, F., Indolfi, C., Jakobsen, L., Janssens, L., Jensen, J., Jeremias, A., Karegren, A., Karlsson, A.C., Kharbanda, R.K., Khashaba, A., Kikuta, Y., Krackhardt, F., Koo, B.K., Koul, S., Laine, M., Lehman, S.J., Lindroos, P., Malik, I.S., Maeng, M., Matsuo, H., Meuwissen, M., Nam, C.W., Niccoli, G., Nijjer, S.S., Olsson, H., Olsson, S.E., Omerovic, E., Panayi, G., Petraco, R., Piek, J.J., Ribichini, F., Samady, H., Samuels, B., Sandhall, L., Sapontis, J., Sen, S., Seto, A.H., Sezer, M., Sharp, A.S.P., Shin, E.S., Singh, J., Takashima, H., Talwar, S., Tanaka, N., Tang, K., Belle, E. van, Royen, N. van, Varenhorst, C., Vinhas, H., Vrints, C.J., Walters, D., Yokoi, H., Frobert, O., Patel, M.R., Serruys, P., Davies, J.E., Gotberg, M., Escaned, J., Ryan, N., Mejia-Renteria, H., Cook, C.M., Dehbi, H.M., Alegria-Barrero, E., Alghamdi, A., Al-Lamee, R., Altman, J., Ambrosia, A., Baptista, S.B., Bertilsson, M., Bhindi, R., Birgander, M., Bojara, W., Brugaletta, S., Buller, C., Calais, F., Silva, P.C., Carlsson, J., Christiansen, E.H., Danielewicz, M., Mario, C. de, Doh, J.H., Erglis, A., Erlinge, D., Gerber, R.T., Going, O., Gudmundsdottir, I., Harle, T., Hauer, D., Hellig, F., Indolfi, C., Jakobsen, L., Janssens, L., Jensen, J., Jeremias, A., Karegren, A., Karlsson, A.C., Kharbanda, R.K., Khashaba, A., Kikuta, Y., Krackhardt, F., Koo, B.K., Koul, S., Laine, M., Lehman, S.J., Lindroos, P., Malik, I.S., Maeng, M., Matsuo, H., Meuwissen, M., Nam, C.W., Niccoli, G., Nijjer, S.S., Olsson, H., Olsson, S.E., Omerovic, E., Panayi, G., Petraco, R., Piek, J.J., Ribichini, F., Samady, H., Samuels, B., Sandhall, L., Sapontis, J., Sen, S., Seto, A.H., Sezer, M., Sharp, A.S.P., Shin, E.S., Singh, J., Takashima, H., Talwar, S., Tanaka, N., Tang, K., Belle, E. van, Royen, N. van, Varenhorst, C., Vinhas, H., Vrints, C.J., Walters, D., Yokoi, H., Frobert, O., Patel, M.R., Serruys, P., Davies, J.E., and Gotberg, M.

Abstract

Contains fulltext : 196266.pdf (Publisher’s version ) (Open Access), OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used t

Published
2018

11. 229Coronary haemodynamics in patients with severe aortic stenosis and coronary artery disease undergoing TAVI: implications for clinical indices of coronary stenosis severity

Author

Ahmad, Y, primary, Gotberg, M, additional, Malik, I S, additional, Mikhail, G W, additional, Howard, J P, additional, Demir, O M, additional, Petraco, R, additional, Iglesias, J F, additional, Francis, D P, additional, Mayet, J, additional, Davies, J E R, additional, and Sen, S, additional

Published
2018
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12. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

Author

Gotberg, M., Christiansen, E. H., Gudmundsdottir, I. J., Sandhall, L., Danielewicz, M., Jakobsen, L., Olsson, S. -E., Ohagen, P., Olsson, H., Omerovic, E., Calais, F., Lindroos, P., Maeng, M., Todt, T., Venetsanos, Dimitrios, James, S. K., Karegren, A., Nilsson, M., Carlsson, J., Hauer, D., Jensen, J., Karlsson, A. -C., Panayi, G., Erlinge, D., Frobert, O., Gotberg, M., Christiansen, E. H., Gudmundsdottir, I. J., Sandhall, L., Danielewicz, M., Jakobsen, L., Olsson, S. -E., Ohagen, P., Olsson, H., Omerovic, E., Calais, F., Lindroos, P., Maeng, M., Todt, T., Venetsanos, Dimitrios, James, S. K., Karegren, A., Nilsson, M., Carlsson, J., Hauer, D., Jensen, J., Karlsson, A. -C., Panayi, G., Erlinge, D., and Frobert, O.

Abstract

BACKGROUND The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODS We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTS A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONS Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was nonin, Funding Agencies|Philips Volcano

Published
2017
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13. Bivalirudin versus Heparin Monotherapy in Myocardial Infarction

Author

Erlinge, D., Omerovic, E., Frobert, O., Linder, R., Danielewicz, M., Hamid, M., Swahn, Eva, Henareh, L., Wagner, H., Hardhammar, P., Sjogren, I., Stewart, J., Grimfjard, P., Jensen, J., Aasa, M., Robertsson, L., Lindroos, P., Haupt, J., Wikstrom, H., Ulvenstam, A., Bhiladvala, P., Lindvall, B., Lundin, A., Todt, T., Ioanes, D., Ramunddal, T., Kellerth, T., Zagozdzon, L., Gotberg, M., Andersson, J., Angeras, O., Ostlund, O., Lagerqvist, B., Held, C., Wallentin, L., Schersten, F., Eriksson, P., Koul, S., James, S., Erlinge, D., Omerovic, E., Frobert, O., Linder, R., Danielewicz, M., Hamid, M., Swahn, Eva, Henareh, L., Wagner, H., Hardhammar, P., Sjogren, I., Stewart, J., Grimfjard, P., Jensen, J., Aasa, M., Robertsson, L., Lindroos, P., Haupt, J., Wikstrom, H., Ulvenstam, A., Bhiladvala, P., Lindvall, B., Lundin, A., Todt, T., Ioanes, D., Ramunddal, T., Kellerth, T., Zagozdzon, L., Gotberg, M., Andersson, J., Angeras, O., Ostlund, O., Lagerqvist, B., Held, C., Wallentin, L., Schersten, F., Eriksson, P., Koul, S., and James, S.

Abstract

BACKGROUND The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y 12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. METHODS In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y(12) inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. RESULTS A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P = 0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P = 0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P = 0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P = 0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P = 0.76). CONCLUSIONS, Funding Agencies|Swedish Heart-Lung Foundation; Swedish Research Council; AstraZeneca; Medicines Company; Swedish Foundation for Strategic Research (as part of the TOTAL-AMI project)

Published
2017
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14. Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions: First Description.

Author

Ali Z.A., Illindala U., Karimi Galougahi K., Matsumura M., Maehara A., Hill J.M., Brinton T.J., Meredith I.T., Fajadet J., Di Mario C., Van Mieghem N., Whitbourn R., Gotberg M., Ali Z.A., Illindala U., Karimi Galougahi K., Matsumura M., Maehara A., Hill J.M., Brinton T.J., Meredith I.T., Fajadet J., Di Mario C., Van Mieghem N., Whitbourn R., and Gotberg M.

Abstract

Objectives This study sought to determine the mechanistic effects of a novel balloon-based lithoplasty system on heavily calcified coronary lesions and subsequent stent placement using optical coherence tomography (OCT). Background The Shockwave Coronary Rx Lithoplasty System (Shockwave Medical, Fremont, California) delivers localized, lithotripsy-enhanced disruption of calcium within the target lesion (i.e., lithoplasty) for vessel preparation before stent implantation. Methods We analyzed OCT findings in 31 patients in whom lithoplasty was used to treat severely calcified stenotic coronary lesions. Results After lithoplasty, intraplaque calcium fracture was identified in 43% of lesions, with circumferential multiple fractures noted in >25%. The frequency of calcium fractures per lesion increased in the most severely calcified plaques (highest tertile vs. lowest tertile; p = 0.009), with a trend toward greater incidence of calcium fracture (77.8% vs. 22.2%; p = 0.057). Post-lithoplasty, mean acute area gain was 2.1 mm2, which further increased with stent implantation, achieving a minimal stent area of 5.94 +/- 1.98 mm2 and mean stent expansion of 112.0 +/- 37.2%. Deep dissections, as part of the angioplasty effect, occurred in 13% of cases and were successfully treated with stent implantation without incidence of acute closure, slow flow/no reflow, or perforation. Conclusions High-resolution imaging by OCT delineated calcium modification with fracture as a major mechanism of action of lithoplasty in vivo and demonstrated efficacy in the achievement of significant acute area gain and favorable stent expansion.Copyright © 2017 American College of Cardiology Foundation

Published
2017

15. P4699Cut-off values for instantaneous wave-free ratio in acute non-culprit stenosis evaluation in patients with ST-segment elevation myocardial infarction (iSTEMI substudy)

Author

Thim, T., primary, Gotberg, M., additional, Frobert, O., additional, Nijveldt, R., additional, Van Royen, N., additional, Baptista, S.B., additional, Koul, S., additional, Kellerth, T., additional, Botker, H.E., additional, Terkelsen, C.J., additional, Christiansen, E.H., additional, Jakobsen, L., additional, Kristensen, S.D., additional, and Maeng, M., additional

Published
2017
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16. Intravascular ultrasound guidance is associated with lower mortality in patients undergoing stenting for unprotected left main coronary artery lesions compared to angiography-guided stent implantation

Author

Andell, P., Karlsson, S., Mohammad, M., Gotberg, M., James, Stefan, Jensen, J., Frobert, O., Angeras, O., Nilsson, J., Omerovic, E., Lagerqvist, Bo, Persson, J., Koul, S., Erlinge, D., Andell, P., Karlsson, S., Mohammad, M., Gotberg, M., James, Stefan, Jensen, J., Frobert, O., Angeras, O., Nilsson, J., Omerovic, E., Lagerqvist, Bo, Persson, J., Koul, S., and Erlinge, D.

Published
2016

18. Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey

Author

Adamo, Marianna, Byrne, Robert A., Baumbach, Andreas, Haude, Michael, Windecker, Stephan, Valgimigli, Marco, Aaroe, J., Abdeltawab, A. A., Accardi, R., Addad, F., Agostoni, P., Alajab, A., Alcázar, E., Alhabil, B., Altug Cakmak, H., Amico, F., Amoroso, G., Anderson, R., Andò, G., Andreou, A. Y., Antoniadis, D., Aquilina, M., Aramberry, L., Auer, J., Auffret, V., Ausiello, A., Austin, D., Avram, A., Ayman, E., Babunashvili, V., Bagur, R., Bakotic, Z., Balducelli, M., Ballesteros, S. M., Baptista, S., Baranauskas, A., Barbeau, G., Bax, M., Benchimol, C., Berroth, R., Biasco, L., Bilal, A., Binias, K., Blanco Mata, R., Boccuzzi, G., Bolognese, L., Boskovic, S., Bourboulis, N., Briguori, C., Bunc, M., Buysschaert, I., Calabro’, P., Campo, G., Candiello, A., Caprotta, U. F., Cardenas, M., Carrilho-Ferreira, P., Carrizo, S., Caruso, M., Cassar, A., Cernigliaro, C., Chacko, G., Chamie, D., Clapp, B., Coceani, M., Colangelo, S., Colombo, A., Comeglio, M., Connaughton, M., Conway, D., Cortese, B., Cosgrave, J., Costa, F., Couvoussis, E., Crimi, G., Crook, R., Cruz-Alvarado, J. E., Curello, S., D’Ascenzo, F., D’Urbano, M., Dana, A., De Backer, O., De Carlo, M., De Cesare, N., De Iaco, G., De La Torre, H. J. M., De Oliveira Netoj, B., Devlin, G. P., Di Lorenzo, E., Díaz, A., Dina, C., Dorsel, T. H., Eberli, F. R., Echeverría, R., Eftychiou, C., Elguindy, A., Ercilla, J., Ernst, A., Esposito, G., Ettori, F., Eufracino, Null, Ezquerra Aguilera, W., Falcone, C., Falu, R. M., Feres, F., Ferlini, M., Fernández, G., Fernández-Rodríguez, D., Fileti, L., Fischetti, D., Florescu, N., Formigli, D., Fouladvand, F., Franco, N., Fresco, C., Frigoli, E., Furmaniuk, J., Gabaldo, K., Galli, M., Galli, S., Garbo, R., Garducci, S., Garg, S., Gavrielatos, G., Gensch, J., Giacchi, G., Giunio, L., Giustino, G., Goldberg, L., Goldsmit, R., Gommeaux, A., González Godínez, H., Gosselin, G., Govorov, A., Grimfjard, P., Gross, E., Grosz, C., Guagliumi, G., Hadad, W., Hadadi, L., Hansen, P. R., Harb, S., Hatrick, R., Hayrapetyan, H. G., Hernández-Enríquez, M., Ho Heo, J., Horvath, I. G., Huan Loh, P., Ibrahim, A. M., Ierna, S., Ilic, I., Imperadore, F., Ionescu-Silva, E., Jacksch, R., James, S., Janiak, B., Jensen, S. E., Jeroen, S., Jugessur, R. K., Kala, P., Kambis, M., Kanakakis, J., Karamasis, G., Karchevsky, D., Karpovskiy, A., Kayaert, P., Kedev, S., Kemala, E., Ketteler, T., Khan, S. Q., Kharlamov, A., Kiernan, T., Kiviniem, T., Koltowski, L., Koskinas, K. C., Kouloumpinis, A., Kraaijeveld, A. O., Krizanic, F., Krötz, B., Kuczmik, W., Kukreja, N., Kuksa, D., Yav, K., Kyriakos, D., Labrunie, A., Laine, M., Lapin, O., Larosa, C., Latib, A., Lattuca, B., Lauer, B., Lefèvre, T., Legrand, V., Lehto, P., Leiva-Pons, J. L., Leone, A. M., Lev, G., Lim, R., Limbruno, U., Linares Vicente, J. A., Lindsay, S., Linnartz, C., Liso, A., Lluberas, R., Locuratolo, N., Lokshyn, S., Lunde, K., Lupi, A., Magnavacchi, P., Maia, F., Mainar, V., Mancone, M., Manolios, M. G., Mansour, S., Mariano, E., Marques, K., Martins, H., Mckenzie, D., Meco, S., Meemook, K., Mehmed, K., Melikyan, A., Mellwig, K. P., Mendiz, O. A., Merkulov, E., Mesquita, H. G., Mezzapelle, G., Miloradovic, V., Mohamed, S., Mohammed, B., Mohammed, F., Mohammed, K., Mohanad, A., Morawiec, B., More, R., Moreno-Martínez, F. L., Mrevlje, B., Muhammad, F., Näveri, H., Nazzaro, M. S., Neary, P., Negus, B. H., Nelson Durval, F. G., Nick, H., Nilva, E., Oldroyd, K. G., Olivares Asencio, C., Omerovic, E., Ortiz, M. A., Ota, H., Otasevic, P., Otieno, H. A., Paizis, I., Papp, E., Pasquetto, G., Patsourakos, N. G., Peels, J., Pelliccia, F., Pennacchi, M., Penzo, C., Perez, P., Perkan, A., Petrou, E., Phipathananunth, W., Pierri, A., Pinheiro, L. F., Pipa, J. L., Piva, T., Polad, J., Porto, I., Poveda, J., Predescu, L., Prog, R., Puri, R., Raco, D. L., Ramazan, O., Ramazzotti, V., Rao, S. V., Raungaard, B., Reczuch, K., Rekik, S., Rhouati, A., Rigattieri, S., Rodríguez-Olivares, R., Roik, M., Romagnoli, E., Román, A. J., Routledge, H., Rubartelli, P., Rubboli, A., Ruiz-García, J., Russo, F., Ruzsa, Z., Ryding, A., Saad, Aly, Sabate, M., Sabouret, P., Sadowski, M., Saia, F., Sanchez Perez, I., Santoro, G. M., Sarenac, D., Saririan, M., Sarma, J., Schuetz, T., Sciahbasi, A., Sebastian, M., Sebik, R., Sesana, M., Hur, Seung-Ho, Sganzerla, P., Shalva, R., Sharma, S., Sheiban, I., Shein, K. K., Shiekh, I. A., Sinha, M., Slhessarenko, J., Smith, D., Smyth, D. W., Sönmez, K., Sood, N., Sourgounis, A., Srdanovic, I., Stables, R. H., Stefanini, G. G., Stewart, J., Stoyanov, N., Suliman, A. A., Suryadevara, R., Suwannasom, P., Tange Veien, K., Tauchert, S., Tebet, M., Testa, L., Thury, A., Tilsted, H. H., Tiroch, K., Torres, A., Tosi, P., Traboulsi, M., Trani, C., Tresoldi, S., Tsigkas, G., Tueller, D., Turri, M., Udovichenko, A. E., Uretsky, B., Van Der Harst, P., Van Houwelingen, K. G., Vandoni, P., Vandormael, M., Varbella, F., Venkitachalam, C. G., Vercellino, M., Vidal-Perez, R., Vigna, C., Vignali, L., Vogt, F., Voudris, V., Vranckx, P., Vrolix, M., Vydt, T., Webster, M., Wijns, W., Woody, W., Wykrzykowska, J., Yazdani, S., Yildiz, A., Yurlevich, D., Zauith, R., Zekanovic, D., Zhao, M., Zimarino, M., Zingarelli, A., Abdelsamad, A. Y., Abo Shaera, E. S., Afshar, M. S., Agatiello, C., Aguiar, P., Ahmad, A. M., Akin, I., Alameda, M., Alegría-Barrero, E., Alejos, R., Alkhashab, K., Alkutshan, R. S. A., Almorraweh, A., Altnji, I., Alvarez Iorio, C., Anchidin, O., Angel, J., Antonopoulos, A., Apshilava, G., Arana, C., Ashikaga, T., Assomull, R., Atef, S. Z., Azmus, A. D., Azzalini, L., Azzouz, A., Baglioni, P., Bampas, G., Basil, M. P., Baumbach, A., Besh, D., Bhushan Sharm, A., Bien Hsien, H., Bihui, L., Bing-Chen, L., Biryukov, S., Blatt, A., Bocchi, E., Boghdady, A., Bonarjee, V. V. S., Bosnjak, I., Bravo Baptista, S., Brinckman, S. L., Buchter, B., Burzotta, F., Cacucci, M., Cagliyan, C. E., Calabrò, P., Cernetti, C., Chávez Mizraym, R., Choo, W. S., Choudhury, R., Cicco, N., Cisneros Clavijo, P., Çitaku, H., Collet, J. P., Consuegra-Sánchez, L., Conte, M., Corral, J. M., Damonte, A., Dangoisse, V., Dastani, M., Della Rosa, F., Deora, S., Devadathan, S., Dharma, S., Di Giorgio, A., Diez, J. L., Dinesha, B., Duplančić, D., El Behwashi, M. F., Elghawaby, H., Elshahawy, O., Eskola, M. J., Etman, A., Eun Gyu, L., Fabiano, L., Facta, A., Fan, Y., Fang-Yang, H., Farag, E., Fathi, Y., Fazeli, N., Federico, P., Fereidoun, M. Z., Fernandez-Nofrerias, E., Flensted Lassen, J., Flessas, D., Fouad, H., Franco-Pelaez, J. A., Fu, Q., Furtado, R., Gadepalli, R., Gallino, R., Gasparetto, V., Gentiletti, A., Gholoobi, A., Ghosh, A. K., Gkizas, S., Golchha, S. K., Goncharov, A., Gössl, M., Götberg, M., Greco, F., Grundeken, M. J., Gupta, D., Gupta, S., Guray, U., Hahalis, G., Hakim Vista, J., Hamid, M. A., Hammoudeh, A., Hasan, A. R. I., Hatsumura, F. E., Heintzen, M. P., Helal, T., Hetherington, S., Hewarathna, U. I., Hioki, H., Hissein, F., Ho-Ping, Y., Homs, S., Huber, K., Ibarra, F. M., Ielasi, A., Ipek, E., Jambunathan, R., Jamshidi, P., Jarrad, I., Javier, W., Jensen, J., Jimenez-Quevedo, P., Kalpak, O., Kan, J., Kanaan, T., Kao, D. H. M., Karamfiloff, K., Karegren, A., Karjalainen, P. P., Kasabov, R., Katsimagklis, G. D., Kaul, U., Khan, A., Kiemeneij, E., Kiviniemi, T., Kleiban, A., Komiyama, N., Konteva, M., Koshy, G., Krepsky, A. M., Kuljit, S., Kulkarni, P., Kumar, V., Kuznetsov, I., Lai, G., Lateef, M. A., Lawand, S., Le Hong, T., Lettieri, C., Levy, G., Lindvall, P., Maitra, A., Makowski, M., Mamas, M. A., Mandal, S. C., Mangalanandan, P., Marin, R., Mashhadi, M., Matsukage, T., Meier, B., Milosavljevic, B., Miro, S. S., Mitov, A., Moeriel, M., Moguel, R., Mohanty, A., Montalescot, G., Mörsdorf, W., Moscato, F., Muniz, A., Muraglia, S., Myć, J., Nada, A., Nair, P., Namazi, M. H., Naraghipour, F., Nguyen, Q. N., Nicosia, A., Nikas, D., Ober, M., Ocaranza-Sánchez, R., Olivecrona, G., Pahlajani, D., Pandey, B. P., Parma, A., Parma, R., Patsilinakos, S. P., Pattam, J., Peddi, S., Perez, P. R., Peruga, J. Z., Pescoller, F., Petrov, I., Piatti, L., Pico-Aracil, F., Pina, J., Piroth, Z., Popa, V., Pourbehi, M. R., Pradhan, A. K., Prida, X. E., Purohit, B. V., Pyun, W. B., Quang Hung, D., Rada, I., Rafizadeh, O., Rahman, M. A., Rai, L., Ramsewak, A., Ravindran, R., Rodriguez De Leiras, O. S., Rodríguez Esteban, M., Roque Figueira, H., Saket, A., Sakhov, O., Saktheeswaran, M. K., Salachas, A., Sallam, A., Sampaolesi, A., Samy, A., Sanchis, J., Santaera, O., Santarelli, A., Santharaj, W. S., Sarango, B., Satheesh, S., Schmitz, T., Schühlen, H., Seewoosagur, R., Segev, A., Seisembekov, V., Semitko, S., Sengottuvelu, G., Sepulveda Varela, P., Sethi, A., Sharma, A., Sharma, R. K., Shi, Hy., Şimşek, M. A., Siqueira, B., Skalidis, E., Slawin, J., Sorokhtey, L., Spaulding, C., Srinivas, B., Srinivasan, M., Stakos, D., Stefanini, G., Stojkovic, S., Tacoy, G., Tawade, M., Tiecco, F., Tondi, S., Torresani, E. M., Tousek, P., Tran, T., Trantalis, G., Triantafyllou, K., Trivedi, R., Trivisonno, A., Tsui, K. L., Türkoğlu, C., Tzung-Dau, W., Ueno, H., Urban, U., Uretsky, B. F., Uscumlic, A., Venugopal, V., Verney, R., Vilar, J. V., Villacorta, V. G., Vishwanath, R., Vlachojannis, G. J., Vlachojannis, M., Vlad, V., Von Birgelen, C., Vukcevic, V., Wahab, A., Waksman, R., Wei-Wen, L., Weisz, G., Whittaker, A., Yadav, A., Yokoi, Y., Zacharoulis, A., Zahran, M., Zamani, J., Ziakas, A., Zimmermann, J. P., Adamo, M., Byrne, R. A., Baumbach, A., Haude, M., Windecker, S., Valgimigli, M., Aaroe, J., Abdeltawab, A. A., Accardi, R., Addad, F., Agostoni, P., Alajab, A., Alcazar, E., Alhabil, B., Altug Cakmak, H., Amico, F., Amoroso, G., Anderson, R., Ando, G., Andreou, A. Y., Antoniadis, D., Aquilina, M., Aramberry, L., Auer, J., Auffret, V., Ausiello, A., Austin, D., Avram, A., Ayman, E., Babunashvili, V., Bagur, R., Bakotic, Z., Balducelli, M., Ballesteros, S. M., Baptista, S., Baranauskas, A., Barbeau, G., Bax, M., Benchimol, C., Berroth, R., Biasco, L., Bilal, A., Binias, K., Blanco Mata, R., Boccuzzi, G., Bolognese, L., Boskovic, S., Bourboulis, N., Briguori, C., Bunc, M., Buysschaert, I., Calabro', P., Campo, G., Candiello, A., Caprotta, U. F., Cardenas, M., Carrilho-Ferreira, P., Carrizo, S., Caruso, M., Cassar, A., Cernigliaro, C., Chacko, G., Chamie, D., Clapp, B., Coceani, M., Colangelo, S., Colombo, A., Comeglio, M., Connaughton, M., Conway, D., Cortese, B., Cosgrave, J., Costa, F., Couvoussis, E., Crimi, G., Crook, R., Cruz-Alvarado, J. E., Curello, S., D'Ascenzo, F., D'Urbano, M., Dana, A., De Backer, O., De Carlo, M., De Cesare, N., De Iaco, G., De La Torre, H. J. M., De Oliveira Netoj, B., Devlin, G. P., Di Lorenzo, E., Diaz, A., Dina, C., Dorsel, T. H., Eberli, F. R., Echeverria, R., Eftychiou, C., Elguindy, A., Ercilla, J., Ernst, A., Esposito, G., Ettori, F., Eufracino, Ezquerra Aguilera, W., Falcone, C., Falu, R. M., Feres, F., Ferlini, M., Fernandez, G., Fernandez-Rodriguez, D., Fileti, L., Fischetti, D., Florescu, N., Formigli, D., Fouladvand, F., Franco, N., Fresco, C., Frigoli, E., Furmaniuk, J., Gabaldo, K., Galli, M., Galli, S., Garbo, R., Garducci, S., Garg, S., Gavrielatos, G., Gensch, J., Giacchi, G., Giunio, L., Giustino, G., Goldberg, L., Goldsmit, R., Gommeaux, A., Gosselin, G., Govorov, A., Gonzalez Godinez, H., Gross, E., Grosz, C., Guagliumi, G., Hadad, W., Hadadi, L., Hansen, P. R., Harb, S., Hatrick, R., Hayrapetyan, H. G., Hernandez-Enriquez, M., Ho Heo, J., Horvath, I. G., Huan Loh, P., Ibrahim, A. M., Ierna, S., Ilic, I., Imperadore, F., Ionescu-Silva, E., Jacksch, R., James, S., Janiak, B., Jensen, S. E., Jeroen, S., Jugessur, R. K., Kala, P., Kambis, M., Kanakakis, J., Karamasis, G., Karchevsky, D., Karpovskiy, A., Kayaert, P., Kedev, S., Kemala, E., Ketteler, T., Khan, S. Q., Kharlamov, A., Kiernan, T., Kiviniem, T., Koltowski, L., Koskinas, K. C., Kouloumpinis, A., Kraaijeveld, A. O., Krizanic, F., Krotz, B., Kuczmik, W., Kukreja, N., Kuksa, D., Yav, K., Kyriakos, D., Labrunie, A., Laine, M., Lapin, O., Larosa, C., Latib, A., Lattuca, B., Lauer, B., Lefevre, T., Legrand, V., Lehto, P., Leiva-Pons, J. L., Leone, A. M., Lev, G., Lim, R., Limbruno, U., Linares Vicente, J. A., Lindsay, S., Linnartz, C., Liso, A., Lluberas, R., Locuratolo, N., Lokshyn, S., Lunde, K., Lupi, A., Magnavacchi, P., Maia, F., Mainar, V., Mancone, M., Manolios, M. G., Mansour, S., Mariano, E., Marques, K., Martins, H., Mckenzie, D., Meco, S., Meemook, K., Mehmed, K., Melikyan, A., Mellwig, K. P., Mendiz, O. A., Merkulov, E., Mesquita, H. G., Mezzapelle, G., Miloradovic, V., Mohamed, S., Mohammed, B., Mohammed, F., Mohammed, K., Mohanad, A., Morawiec, B., More, R., Moreno-Martinez, F. L., Mrevlje, B., Muhammad, F., Naveri, H., Nazzaro, M. S., Neary, P., Negus, B. H., Nelson Durval, F. G., Nick, H., Nilva, E., Oldroyd, K. G., Olivares Asencio, C., Omerovic, E., Ortiz, M. A., Ota, H., Otasevic, P., Otieno, H. A., Paizis, I., Papp, E., Pasquetto, G., Patsourakos, N. G., Peels, J., Pelliccia, F., Pennacchi, M., Penzo, C., Perez, P., Perkan, A., Petrou, E., Phipathananunth, W., Pierri, A., Pinheiro, L. F., Pipa, J. L., Piva, T., Polad, J., Porto, I., Poveda, J., Predescu, L., Prog, R., Puri, R., Raco, D. L., Ramazan, O., Ramazzotti, V., Rao, S. V., Raungaard, B., Reczuch, K., Rekik, S., Rhouati, A., Rigattieri, S., Rodriguez-Olivares, R., Roik, M., Romagnoli, E., Roman, A. J., Routledge, H., Rubartelli, P., Rubboli, A., Ruiz-Garcia, J., Russo, F., Ruzsa, Z., Ryding, A., Saad, A., Sabate, M., Sabouret, P., Sadowski, M., Saia, F., Sanchez Perez, I., Santoro, G. M., Sarenac, D., Saririan, M., Sarma, J., Schuetz, T., Sciahbasi, A., Sebastian, M., Sebik, R., Sesana, M., Hur, S. -H., Sganzerla, P., Shalva, R., Sharma, S., Sheiban, I., Shein, K. K., Shiekh, I. A., Sinha, M., Slhessarenko, J., Smith, D., Smyth, D. W., Sonmez, K., Sood, N., Sourgounis, A., Srdanovic, I., Stables, R. H., Stefanini, G. G., Stewart, J., Stoyanov, N., Suliman, A. A., Suryadevara, R., Suwannasom, P., Tange Veien, K., Tauchert, S., Tebet, M., Testa, L., Thury, A., Tilsted, H. H., Tiroch, K., Torres, A., Tosi, P., Traboulsi, M., Trani, C., Tresoldi, S., Tsigkas, G., Tueller, D., Turri, M., Udovichenko, A. E., Uretsky, B., Van Der Harst, P., Van Houwelingen, K. G., Vandoni, P., Vandormael, M., Varbella, F., Venkitachalam, C. G., Vercellino, M., Vidal-Perez, R., Vigna, C., Vignali, L., Vogt, F., Voudris, V., Vranckx, P., Vrolix, M., Vydt, T., Webster, M., Wijns, W., Woody, W., Wykrzykowska, J., Yazdani, S., Yildiz, A., Yurlevich, D., Zauith, R., Zekanovic, D., Zhao, M., Zimarino, M., Zingarelli, A., Abdelsamad, A. Y., Abo Shaera, E. S., Afshar, M. S., Agatiello, C., Aguiar, P., Ahmad, A. M., Akin, I., Alameda, M., Alegria-Barrero, E., Alejos, R., Alkhashab, K., Alkutshan, R. S. A., Almorraweh, A., Altnji, I., Alvarez Iorio, C., Anchidin, O., Angel, J., Antonopoulos, A., Apshilava, G., Arana, C., Ashikaga, T., Assomull, R., Atef, S. Z., Azmus, A. D., Azzalini, L., Azzouz, A., Baglioni, P., Bampas, G., Basil, M. P., Besh, D., Bhushan Sharm, A., Bien Hsien, H., Bihui, L., Bing-Chen, L., Biryukov, S., Blatt, A., Bocchi, E., Boghdady, A., Bonarjee, V. V. S., Bosnjak, I., Bravo Baptista, S., Brinckman, S. L., Buchter, B., Burzotta, F., Cacucci, M., Cagliyan, C. E., Cernetti, C., Chavez Mizraym, R., Choo, W. S., Choudhury, R., Cicco, N., Cisneros Clavijo, P., Citaku, H., Collet, J. P., Consuegra-Sanchez, L., Conte, M., Corral, J. M., Damonte, A., Dangoisse, V., Dastani, M., Della Rosa, F., Deora, S., Devadathan, S., Dharma, S., Di Giorgio, A., Diez, J. L., Dinesha, B., Duplancic, D., El Behwashi, M. F., Elghawaby, H., Elshahawy, O., Eskola, M. 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G., Vishwanath, R., Vlachojannis, G. J., Vlachojannis, M., Vlad, V., Von Birgelen, C., Vukcevic, V., Wahab, A., Waksman, R., Wei-Wen, L., Weisz, G., Whittaker, A., Yadav, A., Yokoi, Y., Zacharoulis, A., Zahran, M., Zamani, J., Ziakas, A., Zimmermann, J. P., and Cardiology

Subjects
Hirudin, Percutaneous, Antithrombin, medicine.medical_treatment, Psychological intervention, 030204 cardiovascular system & hematology, medical, 0302 clinical medicine, Peptide Fragment, Surveys and Questionnaires, Surveys and Questionnaire, Medicine, Bivalirudin, 030212 general & internal medicine, Societies, Medical, Transradial, Anticoagulant, Hirudins, Middle Aged, Recombinant Protein, Recombinant Proteins, Femoral Artery, Radial Artery, Cardiology, acute coronary syndrome, bivalirudin, transradial, adult, antithrombins, cardiology, femoral artery, hirudins, humans, middle aged, peptide fragments, percutaneous coronary intervention, recombinant proteins, societies, medical, surveys and questionnaires, attitude of health personnel, radial artery, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, Human, medicine.drug, Adult, medicine.medical_specialty, Attitude of Health Personnel, medicine.drug_class, MEDLINE, Antithrombins, 03 medical and health sciences, societies, Percutaneous Coronary Intervention, Internal medicine, Humans, Acute Coronary Syndrome, Peptide Fragments, Management of acute coronary syndrome, business.industry, Percutaneous coronary intervention, medicine.disease, business
Abstract

AIMS Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.

Published
2016

20. Real-time use of instantaneous wave-free ratio: results of the ADVISE in-practice: an international, multicenter evaluation of instantaneous wave-free ratio in clinical practice.

Author

Petraco R, Al-Lamee R, Gotberg M, Sharp A, Hellig F, Nijjer SS, Echavarria-Pinto M, van de Hoef TP, Sen S, Tanaka N, Van Belle E, Bojara W, Sakoda K, Mates M, Indolfi C, De Rosa S, Vrints CJ, Haine S, Yokoi H, Ribichini FL, Meuwissen M, Matsuo H, Janssens L, Katsumi U, Di Mario C, Escaned J, Piek J, and Davies JE

Subjects
Aged, Area Under Curve, Cardiac Catheterization methods, Case-Control Studies, Coronary Angiography methods, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Coronary Circulation, Coronary Stenosis diagnosis
Abstract

Objectives: To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians., Background: The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed., Methods: Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave-free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated., Results: Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROC(AUC)] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROC(AUC) 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROC(AUC) 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification., Conclusion: When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians., (Copyright © 2014 The Author. Published by Elsevier Inc. All rights reserved.)

Published
2014
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21. Coronary artery reperfusion: The ADP receptor P2Y(1) mediates early reactive hyperemia in vivo in pigs.

Author

Olivecrona GK, Gotberg M, Harnek J, Wang L, Jacobson KA, and Erlinge D

Abstract

The physiological mechanisms that regulate reactive hyperemia are not fully understood. We postulated that the endothelial P2Y(1) receptor that release vasodilatory factors in response to ADP might play a vital role in the regulation of coronary flow. Intracoronary flow was measured with a Doppler flow-wire in a porcine model. 2-MeSADP (10(-5) M), ATP (10(-4) M) or UTP (10(-4) M) alone or as co-infusion with a selective P2Y(1) receptor blocker, MRS 2179 (10(-3) M) was locally delivered through the tip of a coronary angioplasty balloon. In separate pigs the coronary artery was occluded with the balloon for 10 min. During the first and tenth minutes of coronary ischemia, 2.5 ml of MRS 2179 (10(-3) M) was delivered distal to the occlusion in 8 pigs, 10 pigs were used as controls. MRS 2179 fully inhibited the 2-MeSADP-mediated coronary flow increase (P < 0.05) with no effect on UTP, indicating selective P2Y(1) inhibition. ATP-mediated flow increase was significantly inhibited by MRS 2179. During reactive hyperemia following coronary occlusion, flow increased by nearly sevenfold. MRS 2179, however, reduced the post-ischemic hyperemia by a mean of 46% during the period 1-2.5 min following balloon deflation (P < 0.05), which corresponds to peak velocity flow during reperfusion. In conclusion, MRS 2179, a selective P2Y(1) receptor blocker, significantly reduces the increased coronary flow caused both by 2-MeSADP and reactive hyperemia in coronary arteries. Thus, ADP acting on the endothelial P2Y(1) receptor may play a major role in coronary flow during post-ischemic hyperemia.

Published
2004
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