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1. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Author

Pazdernik, Michal, Iung, Bernard, Mutlu, Bulent, Alla, François, Riezebos, Robert, Kong, William, Nunes, Maria Carmo Pereira, Pierard, Luc, Srdanovic, Ilija, Yamada, Hirotsugu, De Martino, Andrea, Miglioranza, Marcelo Haertel, Magne, Julien, Piper, Cornelia, Laroche, Cécile, Maggioni, Aldo P., Lancellotti, Patrizio, Habib, Gilbert, and Selton-Suty, Christine

Published
2022
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2. FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction

Author

Bohm, Felix, Mogensen, Brynjolfur, Engstrom, Thomas, Stankovic, Goran, Srdanovic, Ilija, Lonborg, Jacob, Zwackman, Sammy, Hamid, Mehmet, Kellerth, Thomas, Lauermann, Jorg, Kajander, Olli A., Andersson, Jonas, Linder, Rikard, Angeras, Oskar, Renlund, Henrik, Erglis, Andrejs, Menon, Madhav, Schultz, Carl, Laine, Mika, Held, Claes, Ruck, Andreas, Ostlund, Ollie, James, Stefan, Bohm, Felix, Mogensen, Brynjolfur, Engstrom, Thomas, Stankovic, Goran, Srdanovic, Ilija, Lonborg, Jacob, Zwackman, Sammy, Hamid, Mehmet, Kellerth, Thomas, Lauermann, Jorg, Kajander, Olli A., Andersson, Jonas, Linder, Rikard, Angeras, Oskar, Renlund, Henrik, Erglis, Andrejs, Menon, Madhav, Schultz, Carl, Laine, Mika, Held, Claes, Ruck, Andreas, Ostlund, Ollie, and James, Stefan

Abstract

Background The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear.Methods In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization.Results A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P=0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes.Conclusions Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Co, Funding Agencies|Swedish Research Council [2015-00884]; Swedish Heart-Lung Foundation [20150521]; Stockholm County Council (ALF project) [RS2020-0731]; Abbott; Boston Scientific

Published
2024
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3. Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Author

Pazdernik, Michal, Iung, Bernard, Mutlu, Bulent, Alla, François, Riezebos, Robert, Kong, William, Nunes, Maria Carmo Pereira, Pierard, Luc, Srdanovic, Ilija, Yamada, Hirotsugu, De Martino, Andrea, Miglioranza, Marcelo Haertel, Magne, Julien, Piper, Cornelia, Laroche, Cécile, Maggioni, Aldo P., Lancellotti, Patrizio, Habib, Gilbert, and Selton-Suty, Christine

Published
2022
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4. Embolization of Patent Foramen Ovale Closure Device—Rare Complication and Unique Management Approach.

Author

Kovacevic, Mila, Atanaskovic, Marko, Obradovic, Katarina, Todic, Mirko, Crnomarkovic, Branislav, Bjelobrk, Marija, Bjelic, Snezana, Cankovic, Milenko, Milovancev, Aleksandra, and Srdanovic, Ilija

Subjects
PATENT foramen ovale, THERAPEUTIC embolization, ABDOMINAL aorta, FEMORAL artery, STROKE
Abstract

Percutaneous closure of the patent foramen ovale (PFO) is generally regarded as a safe and effective procedure, indicated in patients with a prior PFO-associated stroke. While it is highly safe, rarely, it could be accompanied by a migration of the device, mainly caused by the interplay of a specific PFO morphology and inappropriate device sizing. Herein, we outline a seldom-observed complication of an unintentional detachment of the PFO closure device during implantation, leading to its migration into the abdominal aorta, and a unique management approach. Due to the inability to recapture the occluder with a snare, which is considered to be a mainstay of endovascular retrieval methods, two coronary guidewires were maneuvered through the mesh of the occluder and then captured with a snare proximally to the occluder. This innovative dual-wire–snare system was carefully pulled to the common femoral artery, a position deemed suitable for surgical extraction via arteriotomy, which was achieved successfully. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Percutaneous coronary intervention to treat unprotected left main: Common (un-answered) challenges

Author

Kovacevic, Mila, Burzotta, Francesco, Srdanovic, Ilija, Petrovic, Milovan, and Trani, Carlo

Subjects
left main bifurcation, Treatment Outcome, Percutaneous Coronary Intervention, and stenting techniques, ostial disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Myocardial Revascularization, Humans, PCI, Drug-Eluting Stents, Coronary Artery Disease, Coronary Angiography, Cardiology and Cardiovascular Medicine
Published
2022

7. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry

Author

Kong, William K F, primary, Salsano, Antonio, additional, Giacobbe, Daniele Roberto, additional, Popescu, Bogdan A, additional, Laroche, Cécile, additional, Duval, Xavier, additional, Schueler, Robert, additional, Moreo, Antonella, additional, Colonna, Paolo, additional, Piper, Cornelia, additional, Calvo-Iglesias, Francisco, additional, Badano, Luigi P, additional, Srdanovic, Ilija, additional, Boutoille, David, additional, Huttin, Olivier, additional, Stöhr, Elisabeth, additional, Timóteo, Ana Teresa, additional, Vaskelyte, Jolanta Justina, additional, Sadeghpour, Anita, additional, Tornos, Pilar, additional, Abid, Leila, additional, Poh, Kian Keong, additional, Habib, Gilbert, additional, and Lancellotti, Patrizio, additional

Published
2022
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8. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry

Author

Kong, W, Salsano, A, Giacobbe, D, Popescu, B, Laroche, C, Duval, X, Schueler, R, Moreo, A, Colonna, P, Piper, C, Calvo-Iglesias, F, Badano, L, Srdanovic, I, Boutoille, D, Huttin, O, Stöhr, E, Timóteo, A, Vaskelyte, J, Sadeghpour, A, Tornos, P, Abid, L, Poh, K, Habib, G, Lancellotti, P, Kong, William K F, Salsano, Antonio, Giacobbe, Daniele Roberto, Popescu, Bogdan A, Laroche, Cécile, Duval, Xavier, Schueler, Robert, Moreo, Antonella, Colonna, Paolo, Piper, Cornelia, Calvo-Iglesias, Francisco, Badano, Luigi, Srdanovic, Ilija, Boutoille, David, Huttin, Olivier, Stöhr, Elisabeth, Timóteo, Ana Teresa, Vaskelyte, Jolanta Justina, Sadeghpour, Anita, Tornos, Pilar, Abid, Leila, Poh, Kian Keong, Habib, Gilbert, Lancellotti, Patrizio, Kong, W, Salsano, A, Giacobbe, D, Popescu, B, Laroche, C, Duval, X, Schueler, R, Moreo, A, Colonna, P, Piper, C, Calvo-Iglesias, F, Badano, L, Srdanovic, I, Boutoille, D, Huttin, O, Stöhr, E, Timóteo, A, Vaskelyte, J, Sadeghpour, A, Tornos, P, Abid, L, Poh, K, Habib, G, Lancellotti, P, Kong, William K F, Salsano, Antonio, Giacobbe, Daniele Roberto, Popescu, Bogdan A, Laroche, Cécile, Duval, Xavier, Schueler, Robert, Moreo, Antonella, Colonna, Paolo, Piper, Cornelia, Calvo-Iglesias, Francisco, Badano, Luigi, Srdanovic, Ilija, Boutoille, David, Huttin, Olivier, Stöhr, Elisabeth, Timóteo, Ana Teresa, Vaskelyte, Jolanta Justina, Sadeghpour, Anita, Tornos, Pilar, Abid, Leila, Poh, Kian Keong, Habib, Gilbert, and Lancellotti, Patrizio

Abstract

AIM: Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS: This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION: The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.

Published
2022

9. Intravascular imaging and drug-coated balloons for unprotected left main percutaneous coronary interventions: Questions with a predictable or unpredictable answer? Author's reply

Author

Kovacevic, Mila, Burzotta, Francesco, Srdanovic, Ilija, Petrovic, Milovan, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Trani, Carlo (ORCID:0000-0001-9777-013X), Kovacevic, Mila, Burzotta, Francesco, Srdanovic, Ilija, Petrovic, Milovan, Trani, Carlo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Trani, Carlo (ORCID:0000-0001-9777-013X)

Abstract

N/A

Published
2022

10. Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial

Author

Banovic, Marko, primary, Putnik, Svetozar, additional, Penicka, Martin, additional, Doros, Gheorghe, additional, Deja, Marek A., additional, Kockova, Radka, additional, Kotrc, Martin, additional, Glaveckaite, Sigita, additional, Gasparovic, Hrvoje, additional, Pavlovic, Nikola, additional, Velicki, Lazar, additional, Salizzoni, Stefano, additional, Wojakowski, Wojtek, additional, Van Camp, Guy, additional, Nikolic, Serge D., additional, Iung, Bernard, additional, Bartunek, Jozef, additional, Barbato, Emanuele, additional, De Bruyne, Bernard, additional, Casselman, Filip, additional, De Grieck, Ivan, additional, Heyse, Alex, additional, Stockman, Bernard, additional, Vanderheyden, Marc, additional, Van Durme, Frederik, additional, Van Praet, Frank, additional, Wyffels, Eric, additional, Biocina, Bojan, additional, Manola, Sime, additional, Pirk, Jan, additional, Cura-Stura, Erik, additional, Rinaldi, Mauro, additional, Maria De Ferrari, Gaetano, additional, Fava, Antonella, additional, Maria Richiardi, Elena, additional, Celutkiene, Jelena, additional, Filipova, Marta, additional, Ciosek, Joanna, additional, Guzy, Michal, additional, Kurzelowski, Radoslaw, additional, Bjelobrk, Marija, additional, Ilic, Aleksandra, additional, Kovacevic, Mila, additional, Miljkovic, Tatjana, additional, Preveden, Andrej, additional, Srdanovic, Ilija, additional, Aleksandric, Srdjan, additional, Asanin, Milika, additional, Beleslin, Branko, additional, Bojanic, Milica, additional, Boskovic, Nikola, additional, Bosic, Sladjana, additional, Cvetinovic, Natasa, additional, Dedovic, Vladimir, additional, Giga, Vojislav, additional, Jandric, Predrag, additional, Jaukovic, Milena, additional, Jovanovic, Miodrag, additional, Kovacevic-Kuzmanovic, Ana, additional, Loncar, Goran, additional, Manojlovic, Andrea, additional, Matkovic, Milos, additional, Mitrovic, Predrag, additional, Nedeljkovic, Ivana, additional, Nedeljkovic, Milan, additional, Petrovic, Olgica, additional, Ristic, Arsen, additional, Seper, Mirjana, additional, Simic, Dragan, additional, Stankovic, Sanja, additional, Stojkovic, Sinisa, additional, Vukcevic, Vladan, additional, and Zivic, Katarina, additional

Published
2022
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11. Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

Author

Gluvic Zoran, Dzudovic Boris, Kafedzic Srdjan, Mladenovic Zorica, Nikolic Maja, Zec Nenad, Neskovic Aleksandar, Pekovic Sandra, Matijasevic Jovan, Obradovic Slobodan, Subotic Bojana, Kovacevic-Kuzmanovic Ana, Srdanovic Ilija, Jovanovic Ljiljana, Salinger-Martinovic Sonja, Miloradovic Vladimir, Markovic-Nikolic Natasa, Bokan Aleksandar, Pancevacki Sasa, Kovacevic-Preradovic Tamara, Konstantinides Stavros, Trobok Jadranka, and Kos Ljiljana

Subjects
Ejection fraction, medicine.medical_specialty, Heart failure, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Internal medicine, Diseases of the circulatory (Cardiovascular) system, Medicine, Original Research Article, 030212 general & internal medicine, Mortality, Risk factor, business.industry, Pulmonary embolism, Hazard ratio, Atrial fibrillation, medicine.disease, 3. Good health, Blood pressure, RC666-701, Cardiology, Cardiology and Cardiovascular Medicine, business, Heart failure with preserved ejection fraction
Abstract

Aims This study aimed to investigate whether the risk of short‐term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7‐day (intrahospital) and 30‐day all‐cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline‐proposed criteria. A 7‐day (intrahospital) and 30‐day all‐cause mortality was 18.5% vs. 7.3% vs. 4.5% (P

Published
2020

12. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry

Author

Kong, William K F, Salsano, Antonio, Giacobbe, Daniele Roberto, Popescu, Bogdan A, Laroche, Cécile, Duval, Xavier, Schueler, Robert, Moreo, Antonella, Colonna, Paolo, Piper, Cornelia, Calvo-Iglesias, Francisco, Badano, Luigi P, Srdanovic, Ilija, Boutoille, David, Huttin, Olivier, Stöhr, Elisabeth, Timóteo, Ana Teresa, Vaskelyte, Jolanta-Justina, Sadeghpour, Anita, Tornos, Pilar, Abid, Leila, Poh, Kian Keong, Habib, Gilbert, Lancellotti, Patrizio, Kong, W, Salsano, A, Giacobbe, D, Popescu, B, Laroche, C, Duval, X, Schueler, R, Moreo, A, Colonna, P, Piper, C, Calvo-Iglesias, F, Badano, L, Srdanovic, I, Boutoille, D, Huttin, O, Stöhr, E, Timóteo, A, Vaskelyte, J, Sadeghpour, A, Tornos, P, Abid, L, Poh, K, Habib, G, and Lancellotti, P

Subjects
Heart valves, Endocarditis, Infective endocarditi, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Endocarditis, Bacterial, Blood culture-negative endocarditis, Blood culture-negative endocarditi, Diagnosis, Humans, Surgery, Endocarditi, Registries, Cardiac Surgical Procedures, Infective endocarditis, Cardiology and Cardiovascular Medicine, Heart valve, Diagnosi, Proportional Hazards Models, Retrospective Studies
Abstract

Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). Methods and results This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04–1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41–0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. Conclusion The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.

Published
2022

14. Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

Author

Obradovic, Slobodan, primary, Dzudovic, Boris, additional, Subotic, Bojana, additional, Matijasevic, Jovan, additional, Mladenovic, Zorica, additional, Bokan, Aleksandar, additional, Trobok, Jadranka, additional, Pekovic, Sandra, additional, Salinger‐Martinovic, Sonja, additional, Jovanovic, Ljiljana, additional, Kos, Ljiljana, additional, Kovacevic‐Preradovic, Tamara, additional, Nikolic, Maja, additional, Miloradovic, Vladimir, additional, Kovacevic‐Kuzmanovic, Ana, additional, Zec, Nenad, additional, Markovic‐Nikolic, Natasa, additional, Srdanovic, Ilija, additional, Gluvic, Zoran, additional, Kafedzic, Srdjan, additional, Pancevacki, Sasa, additional, Neskovic, Aleksandar, additional, and Konstantinides, Stavros, additional

Published
2020
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15. Renal dysfunction as intrahospital prognostic indicator in acute pulmonary embolism

Author

Salinger-Martinovic, Sonja, primary, Dimitrijevic, Zorica, additional, Stanojevic, Dragana, additional, Momčilović, Stefan, additional, Kostic, Tomislav, additional, Koracevic, Goran, additional, Subotic, Bojana, additional, Dzudovic, Boris, additional, Stefanovic, Branislav, additional, Matijasevic, Jovan, additional, Miric, Milica, additional, Markovic-Nikolic, Natasa, additional, Nikolic, Maja, additional, Miloradovic, Vladimir, additional, Kos, Ljiljana, additional, Kovacevic-Preradovic, Tamara, additional, Srdanovic, Ilija, additional, Stanojevic, Jelena, additional, and Obradovic, Slobodan, additional

Published
2020
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16. Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor

Author

Bianco, Matteo, primary, D'ascenzo, Fabrizio, additional, Raposeiras Roubin, Sergio, additional, Kinnaird, Tim, additional, Peyracchia, Mattia, additional, Ariza-Solé, Albert, additional, Cerrato, Enrico, additional, Manzano-Fernández, Sergio, additional, Gravinese, Carol, additional, Templin, Christian, additional, Destefanis, Paola, additional, Velicki, Lazar, additional, Luciano, Alessia, additional, Xanthopoulou, Ioanna, additional, Rinaldi, Mauro, additional, Rognoni, Andrea, additional, Varbella, Ferdinando, additional, Boccuzzi, Giacomo, additional, Omedè, Pierluigi, additional, Montabone, Andrea, additional, Bernardi, Alessandro, additional, Taha, Salma, additional, Rossini, Roberta, additional, Durante, Alessandro, additional, Gili, Sebastiano, additional, Magnani, Giulia, additional, Autelli, Michele, additional, Grosso, Alberto, additional, Blanco, Pedro Flores, additional, Giustetto, Carla, additional, Garay, Alberto, additional, Quadri, Giorgio, additional, Queija, Berenice Caneiro, additional, Srdanovic, Ilija, additional, Paz, Rafael Cobas, additional, Fernández, María Cespón, additional, Pousa, Isabel Muñoz, additional, Gallo, Diego, additional, Morbiducci, Umberto, additional, Dominguez-Rodriguez, Alberto, additional, Lopez-Cuenca, Ángel, additional, Cequier, Angel, additional, Alexopoulos, Dimitrios, additional, Iñiguez-Romo, Andres, additional, Pozzi, Roberto, additional, Assi, Emad Abu, additional, and Valgimigli, Marco, additional

Published
2020
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27. Late stent thrombosis

Author

Petrovic, Milovan, primary, Bikicki, Miroslav, additional, Panic, Gordana, additional, Canji, Tibor, additional, Srdanovic, Ilija, additional, and Ivanovic, Vladimir, additional

Published
2009
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32. Telemedicine and cardiology

Author

Jelkic, Nikola, primary, Canji, Tibor, additional, Ivanovic, Vladimir, additional, Srdanovic, Ilija, additional, Mirkovic, Milena, additional, and Vujin, Bojan, additional

Published
2003
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34. Complete Versus Culprit-Only Revascularization in Older Patients With ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis.

Author

Campo G, Böhm F, Engstrøm T, Smits PC, Elgendy IY, McCann GP, Wood DA, Serenelli M, James S, Høfsten DE, Boxm-de Klerk BM, Banning A, Cairns JA, Pavasini R, Stankovic G, Kala P, Kelbæk H, Barbato E, Srdanovic I, Hamza M, Banning AS, Biscaglia S, and Mehta S

Subjects
Humans, Aged, Female, Aged, 80 and over, Male, Treatment Outcome, Percutaneous Coronary Intervention mortality, Age Factors, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction surgery, ST Elevation Myocardial Infarction therapy, Myocardial Revascularization methods, Randomized Controlled Trials as Topic
Abstract

Background: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies., Methods: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction., Results: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms., Conclusions: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point., Registration: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898., Competing Interests: None.

Published
2024
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35. FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction.

Author

Böhm F, Mogensen B, Engstrøm T, Stankovic G, Srdanovic I, Lønborg J, Zwackman S, Hamid M, Kellerth T, Lauermann J, Kajander OA, Andersson J, Linder R, Angerås O, Renlund H, Ērglis A, Menon M, Schultz C, Laine M, Held C, Rück A, Östlund O, and James S

Subjects
Aged, Female, Humans, Male, Middle Aged, Follow-Up Studies, Kaplan-Meier Estimate, Myocardial Infarction mortality, Myocardial Infarction therapy, Registries, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Reoperation, Europe, Australasia, Coronary Artery Disease complications, Coronary Artery Disease mortality, Coronary Artery Disease therapy, Fractional Flow Reserve, Myocardial, Percutaneous Coronary Intervention methods, ST Elevation Myocardial Infarction etiology, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction physiopathology, ST Elevation Myocardial Infarction therapy, Myocardial Revascularization methods
Abstract

Background: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear., Methods: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization., Results: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes., Conclusions: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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36. Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients.

Author

Sreckovic MJ, Jagic N, Miloradovic V, Neskovic A, Soldatovic I, and Srdanovic I

Abstract

Introduction: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood., Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR)., Material and Methods: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire., Results: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis., Conclusions: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

Published
2017
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