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Coronary Artery Disease: HELP
Articles by Alaide Chieffo
Based on 97 articles published since 2010
(Why 97 articles?)
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Between 2010 and 2020, A. Chieffo wrote the following 97 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. 2018

Lassen, Jens Flensted / Burzotta, Francesco / Banning, Adrian P / Lefèvre, Thierry / Darremont, Olivier / Hildick-Smith, David / Chieffo, Alaide / Pan, Manuel / Holm, Niels Ramsing / Louvard, Yves / Stankovic, Goran. ·Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. ·EuroIntervention · Pubmed #29061550.

ABSTRACT: The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field of coronary artery bifurcation interventions and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, two-day compact meeting, dedicated to bifurcations, which brings together physicians, pathologists, engineers, biologists, physicists, mathematicians, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement that reflects the unique opportunity of combining the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management. A series of consensus sessions dedicated to specific topics, to strengthen the consensus debates and focus the discussions, was introduced at this year's meeting. The sessions comprise an intensive overview of the present literature, a pro and con debate and a voting system, to guide the consensus-building process. The present document represents the summary of the up-to-date EBC consensus and recommendations from the 12th annual EBC meeting in 2016 in Rotterdam.

2 Guideline Consensus from the 7th European Bifurcation Club meeting. 2013

Stankovic, Goran / Lefèvre, Thierry / Chieffo, Alaide / Hildick-Smith, David / Lassen, Jens Flensted / Pan, Manuel / Darremont, Olivier / Albiero, Remo / Ferenc, Miroslaw / Finet, Gérard / Adriaenssens, Tom / Koo, Bon-Kwon / Burzotta, Francesco / Louvard, Yves / Anonymous4790754. ·Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. gorastan@sbb.rs ·EuroIntervention · Pubmed #23552575.

ABSTRACT: -- No abstract --

3 Editorial Percutaneous treatment of left main disease: Still learning about the optimal PCI strategy. 2016

Ancona, Marco / Chieffo, Alaide. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. ·Cardiovasc Revasc Med · Pubmed #27988083.

ABSTRACT: -- No abstract --

4 Editorial Decision making between percutaneous coronary intervention or bypass surgery in multi-vessel coronary disease. 2014

Buchanan, Gill Louise / Giustino, Gennaro / Chieffo, Alaide. ·Department of Cardiology, North Cumbria University Hospitals NHS Trust, Carlisle, United Kingdom. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. ·Rev Esp Cardiol (Engl Ed) · Pubmed #24863589.

ABSTRACT: -- No abstract --

5 Editorial One versus two stents: the cause or the effect? 2014

Colombo, Antonio / Chieffo, Alaide. ·Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it. · Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy. ·JACC Cardiovasc Interv · Pubmed #24529930.

ABSTRACT: -- No abstract --

6 Review A Practical Approach to the Management of Complications During Percutaneous Coronary Intervention. 2018

Giannini, Francesco / Candilio, Luciano / Mitomo, Satoru / Ruparelia, Neil / Chieffo, Alaide / Baldetti, Luca / Ponticelli, Francesco / Latib, Azeem / Colombo, Antonio. ·Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: giannini.francesco@hsr.it. · Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cardiovascular Department, Hammersmith Hospital, Imperial College, London, United Kingdom. · Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy. ·JACC Cardiovasc Interv · Pubmed #30236352.

ABSTRACT: Percutaneous coronary intervention relieves symptoms in patients with chronic ischemic heart disease resistant to optimal medical therapy and alters the natural history of acute coronary syndromes. However, adverse procedural outcomes may occur during the intervention. Knowledge of possible complications and their timely management are essential for the practicing cardiologist and can be life-saving for the patient. In this review, the authors summarize potential complications of percutaneous coronary intervention focusing on their practical management.

7 Review Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club. 2018

Burzotta, Francesco / Lassen, Jens Flensted / Banning, Adrian P / Lefèvre, Thierry / Hildick-Smith, David / Chieffo, Alaide / Darremont, Olivier / Pan, Manuel / Chatzizisis, Yiannis S / Albiero, Remo / Louvard, Yves / Stankovic, Goran. ·Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. ·EuroIntervention · Pubmed #29786539.

ABSTRACT: The 2017 European Bifurcation Club (EBC) meeting was held in Porto (Portugal) and allowed a multidisciplinary international faculty to review and discuss the latest data collected in the field of coronary bifurcation interventions. In particular, the topic of percutaneous coronary intervention (PCI) on left main coronary artery (LM) disease was highlighted as a contemporary priority. Herein, we summarise the key LM anatomy features, the diagnostic modalities and available data that are relevant for a patient's procedural management. Since the clinical outcomes of patients undergoing PCI on LM disease may depend on both PCI team organisation and PCI performance, the optimal catheterisation laboratory set-up and the rationales for device and technique selection are critically reviewed. The best lesion preparation modalities, the different DES implantation technique choices and the strategies to be considered during PCI on unprotected LM for optimal PCI results are reviewed step by step.

8 Review Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. 2017

D'Ascenzo, Fabrizio / Iannaccone, Mario / Saint-Hilary, Gaelle / Bertaina, Maurizio / Schulz-Schüpke, Stefanie / Wahn Lee, Cheol / Chieffo, Alaide / Helft, Gerard / Gili, Sebastiano / Barbero, Umberto / Biondi Zoccai, Giuseppe / Moretti, Claudio / Ugo, Fabrizio / D'Amico, Maurizio / Garbo, Roberto / Stone, Gregg / Rettegno, Sara / Omedè, Pierluigi / Conrotto, Federico / Templin, Christian / Colombo, Antonio / Park, Seung-Jung / Kastrati, Adnan / Hildick-Smith, David / Gasparini, Mauro / Gaita, Fiorenzo. ·Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy. · Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy. · Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy. · Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany. · Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy. · Department of Cardiology, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France. · Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland. · Department of Cardiology, La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100 Latina, Italy. · Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy. · Department of Cardiology, Columbia University Medical Center, USA Cardiovascular Research Foundation, 161 Ft. Washington Ave. Herbert Irving Pavilion 6th Floor, New York, NY 10032 212.305.7060, USA. · Department of Cardiology, Sussex Cardiac Centre, Barry Building, Eastern Rd, Brighton BN2 5BE, UK. ·Eur Heart J · Pubmed #29020300.

ABSTRACT: Aims: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined. Methods and results: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT. Conclusion: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

9 Review Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. 2017

Palmerini, Tullio / Della Riva, Diego / Benedetto, Umberto / Bacchi Reggiani, Letizia / Feres, Fausto / Abizaid, Alexandre / Gilard, Martine / Morice, Marie-Claude / Valgimigli, Marco / Hong, Myeong-Ki / Kim, Byeong-Keuk / Jang, Yangsoo / Kim, Hyo-Soo / Park, Kyung Woo / Colombo, Antonio / Chieffo, Alaide / Sangiorgi, Diego / Biondi-Zoccai, Giuseppe / Généreux, Philippe / Angelini, Gianni D / Pufulete, Maria / White, Jonathon / Bhatt, Deepak L / Stone, Gregg W. ·Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy. · Bristol Heart Institute, University of Bristol School of Clinical Sciences, Bristol, Bristol, UK. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Department of Cardiology, Brest University, Brest, France. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · Swiss Cardiovascular Center, Bern, Switzerland. · Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · San Raffaele Scientific Institute, Milan, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA. ·Eur Heart J · Pubmed #28110296.

ABSTRACT: Aim: We sought to determine whether the optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) placement varies according to clinical presentation. Methods and Results: We performed an individual patient data pairwise and network meta-analysis comparing short-term (≤6-months) versus long-term (1-year) DAPT as well as 3-month vs. 6-month vs 1-year DAPT. The primary study outcome was the 1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST). Six trials were included in which DAPT after DES consisted of aspirin and clopidogrel. Among 11 473 randomized patients 6714 (58.5%) had stable CAD and 4758 (41.5%) presented with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina. In ACS patients, ≤6-month DAPT was associated with non-significantly higher 1-year rates of MI or ST compared with 1-year DAPT (Hazard Ratio (HR) 1.48, 95% Confidence interval (CI) 0.98-2.22; P = 0.059), whereas in stable patients rates of MI and ST were similar between the two DAPT strategies (HR 0.93, 95%CI 0.65-1.35; P = 0.71; Pinteraction = 0.09). By network meta-analysis, 3-month DAPT, but not 6-month DAPT, was associated with higher rates of MI or ST in ACS, whereas no significant differences were apparent in stable patients. Short DAPT was associated with lower rates of major bleeding compared with 1-year DAPT, irrespective of clinical presentation. All-cause mortality was not significantly different with short vs. long DAPT in both patients with stable CAD and ACS. Conclusions: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks.

10 Review Left Main Percutaneous Coronary Intervention. 2016

Ruparelia, Neil / Chieffo, Alaide. ·Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK. · Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy. Electronic address: alaide.chieffo@hsr.it. ·Interv Cardiol Clin · Pubmed #28582198.

ABSTRACT: Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.

11 Review Bioresorbable Scaffolds for the Management of Coronary Bifurcation Lesions. 2016

Kawamoto, Hiroyoshi / Ruparelia, Neil / Tanaka, Akihito / Chieffo, Alaide / Latib, Azeem / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College, London, United Kingdom. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it. ·JACC Cardiovasc Interv · Pubmed #27198679.

ABSTRACT: The use of bioresorbable scaffolds (BRS) may be associated with benefits including restoration of endothelial function, positive vessel remodeling, and reduced risk for very late (stent) thrombosis compared with metallic stents by virtue of their complete absorption within 3 to 4 years of implantation. When treating bifurcation lesions, these advantages may be even more pronounced. The aim of this review is to summarize current experiences and technical considerations of bifurcation treatment with BRS. Because of the physical properties of current-generation BRS, there are concerns with regard to the efficacy and safety of this novel technology for the treatment of bifurcations, with the potential for increased rates of scaffold thrombosis and side-branch occlusions, and as a consequence, bifurcations have been excluded from the major BRS trials. Nevertheless, BRS have been used for this indication in clinical practice, as evidenced by "real-world" registries. Considering the potential limitations, specific technical considerations and modified bifurcation strategies should be used in an attempt to attenuate problems and achieve optimal procedural and clinical outcomes.

12 Review Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. 2016

Lassen, Jens Flensted / Holm, Niels Ramsing / Banning, Adrian / Burzotta, Francesco / Lefèvre, Thierry / Chieffo, Alaide / Hildick-Smith, David / Louvard, Yves / Stankovic, Goran. ·Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. ·EuroIntervention · Pubmed #27173860.

ABSTRACT: Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is, despite a fast growing body of scientific literature, the subject of considerable debate. The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field, and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, compact meeting, dedicated to bifurcations, which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinions of interventional cardiologists with the opinions of a large variety of other scientists on bifurcation management. The present 11th EBC consensus document represents the summary of the up-to-date EBC consensus and recommendations. It points to the fact that there is a multitude of strategies and approaches to bifurcation stenting within the provisional strategy and in the different two-stent strategies. The main EBC recommendation for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. The consensus document covers a moving target. Much more scientific work is needed in non-left main (LM) and LM bifurcation lesions for continuous improvement of the outcome of our patients.

13 Review Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents. 2016

D'Ascenzo, Fabrizio / Moretti, Claudio / Bianco, Matteo / Bernardi, Alessandro / Taha, Salma / Cerrato, Enrico / Omedè, Pierluigi / Montefusco, Antonio / Frangieh, Antonio H / Lee, Cheol W / Campo, Gianluca / Chieffo, Alaide / Quadri, Giorgio / Pavani, Marco / Zoccai, Giuseppe B / Gaita, Fiorenzo / Park, Seung-Jung / Colombo, Antonio / Templin, Christian / Lüscher, Thomas F / Stone, Gregg W. ·Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. Electronic address: meshmeshaya11@yahoo.com. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. · Division of Cardiology, A.O.U San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. · Cardiology Department, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy; Cardiology Department, LTTA Center, Ferrara, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. ·Am J Cardiol · Pubmed #27134057.

ABSTRACT: The purpose of the study was to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention, especially in the era of second-generation drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months) DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death, myocardial infarction (MI), stent thrombosis (ST), and major bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering everolimus-eluting and fast-release zotarolimus-eluting stents separately. Shorter DAPT was inferior to longer DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major bleeding was reduced by shorter DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion, DAPT for ≤6 months is reasonable for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents, with the benefit of less major bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to DAPT duration should take into account the competing risks of bleeding and ischemic complications after present-generation DES.

14 Review Is There Still a Survival Advantage to Bypass Surgery Over Percutaneous Intervention in the Modern Era? 2015

Buchanan, Gill Louise / Chieffo, Alaide / Colombo, Antonio. ·Department of Cardiology, North Cumbria University NHS Trust, Carlisle, United Kingdom. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. Electronic address: colombo.antonio@hsr.it. ·Prog Cardiovasc Dis · Pubmed #26363081.

ABSTRACT: The method of revascularization for multi-vessel coronary artery disease (MVD) has traditionally been coronary artery bypass grafting (CABG), however, due to recent advances in the field of percutaneous coronary intervention (PCI), this latter technique has gained in popularity and its role in guidelines has been promoted. This review aims to address the current data available for the treatment of patients with complex coronary disease, including the specific disease subset in those with diabetes mellitus, focusing on the importance of risk stratification and review by the 'Heart Team'. The concept of complete versus incomplete revascularization and the assessment of lesions utilizing functional techniques are discussed. Over recent years, PCI has grown to become the most frequently performed therapeutic intervention in medicine and continues to grow. There are encouraging data that this is an effective and safe treatment option in selected patients, however, neither strategy alone can provide a solution for the entire spectrum of patients with MVD.

15 Review Targeting transradial approach. 2015

Giustino, G / Cota, L / Chieffo, A. ·San Raffaele Scientific Institute Interventional Cardiology Unit, Milan, Italy - chieffo.alaide@hsr.it. ·Panminerva Med · Pubmed #25373398.

ABSTRACT: Radial access for percutaneous coronary interventions (PCI) emerged as a valid alternative to the standard femoral access with the aim of reduce the incidence of access-site bleeding and consequently improve clinical outcomes. Access-site bleeding is still one of the most common complications after PCI and is associated with increased short- and long-term morbidity and mortality. Benefits in access-site bleeding have been consistently observed in high-risk patients undergoing PCI and in particular in STEMI patients where the antithrombotic regimen is more aggressive. Moreover, other advantages with TR access have been reported including better cost-effectiveness, patient preference, reduced in-hospital length-of-stay, earlier patient ambulation, increased safety in patients on oral anticoagulant and the potential for same-day hospital discharge. The benefits of transradial access in PCI led the interventional community to expand its use to endovascular interventions and more recently, to cardiac structural interventions such as transcatheter aortic valve implantation. The aim of this review is to try to give to the reader a wide view of the state-of-the-art of transradial access in PCI and its current use in endovascular and structural interventions.

16 Review Drug-eluting stent outcomes in diabetes. 2014

Bernelli, Chiara / Chan, Jaclyn / Chieffo, Alaide. ·Interventional Cardiology Unit, San Raffaele Scientific Institute , Via Olgettina 60 20132, Milan , Italy. ·Expert Rev Cardiovasc Ther · Pubmed #24345095.

ABSTRACT: Diabetic population still remains a challenging subgroup of patients for percutaneous coronary intervention (PCI). However, with rapid advancements of PCI techniques, devices and adjunctive drug therapy, clinical outcomes for diabetic patients after PCI have markedly improved. The plethora of recent encouraging data with newer generation drug-eluting stent (DES), with a lower frequency of major cardiac adverse events, lead to an increasing use of DES in this particular high-risk population. However, diabetes remains an important risk factor for coronary events, even in the DES era. This review summarizes the outcomes in diabetic patients undergoing PCI with DES implantation.

17 Review Current management of left main coronary artery disease. 2012

Fajadet, Jean / Chieffo, Alaide. ·Clinique Pasteur, Toulouse, France. fajadet@interv-cardio-toul.com ·Eur Heart J · Pubmed #22210689.

ABSTRACT: Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery (ULMCA) disease. Over the last 20 years, improvement in stent technology and operators experience explained the increased number of reports on the results of percutaneous coronary interventions (PCIs) for the treatment of left main (LM) coronary artery lesion. The recent data comparing efficacy and safety of PCIs using drug-eluting stent and coronary artery bypass surgery showed comparable results in terms of safety and a lower need for repeat revascularization for coronary artery bypass surgery. Patient selection for both techniques is fundamental and directly impacts the clinical outcome. Further randomized trials must be conducted to precise the indications of both techniques of revascularization in the treatment of LM disease.

18 Review Tools & techniques: left main coronary artery percutaneous coronary intervention. 2011

Ielasi, Alfonso / Chieffo, Alaide. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. ·EuroIntervention · Pubmed #21330253.

ABSTRACT: -- No abstract --

19 Article Safety and efficacy of polymer-free biolimus-eluting stents versus ultrathin stents in unprotected left main or coronary bifurcation: A propensity score analysis from the RAIN and CHANCE registries. 2019

D'Ascenzo, Fabrizio / Gaido, Luca / Bernardi, Alessandro / Saglietto, Andrea / Franzé, Alfonso / Ielasi, Alfonso / Trabattoni, Daniela / Di Biasi, Maurizio / Infantino, Vincenzo / Rognoni, Andrea / Helft, Gerard / Gangor, Andrea / Latini, Roberto A / De Luca, Leonardo / Mitomo, Satoru / Ugo, Fabrizio / Smolka, Grzegorz / Huczek, Zenon / Cortese, Bernardo / Capodanno, Davide / Chieffo, Alaide / Piazza, Fabio / di Mario, Carlo / Poli, Arnaldo / D'Urbano, Maurizio / Romeo, Francesco / Giammaria, Massimo / Varbella, Ferdinando / Sheiban, Imad / Escaned, Javier / De Ferrari, Gaetano M. ·Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy. · Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy. · Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy. · Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy. · Division of Cardiology, University of Milan, Milan, Italy. · Cardiology Unit, ASST Fatebenefratelli/Sacco, Sacco Hospital, Milan, Italy. · Division of Cardiology, Ospedale di Ciriè, Ciriè TO, Italy. · Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy. · Division of Cardiology, Pierre and Marie Curie University, Paris, France. · Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy. · Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy. · Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan. · Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy. · Department of Cardiology, Medical University of Silesia, Katowice, Poland. · Division of Cardiology, University Clinical Hospital, Warsaw, Poland. · Division of Cardiology, San Carlo Clinic, Milan, Italy. · Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy. · Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy. · Cardiology Unit-Catheterization Laboratory, SS. Annunziata Hospital, University Hospital of Sassari, Sassari, Italy. · Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. · ASST Milanese Ovest, Legnano Civil Hospital, Legnano, Milan, Italy. · Cardiology Unit, ASST Milanese Ovest, Magenta Hospital, Magenta, Milan, Italy. · Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy. · Department of Cardiology, Infermi Hospital, Rivoli, Italy. · Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. · Division of Cardiology, Interventional Cardiology Pederzoli Hospital Peschiera del Garda, Verona, Italy. · Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain. ·Catheter Cardiovasc Interv · Pubmed #31385427.

ABSTRACT: OBJECTIVES: Evaluate safety and efficacy of polymer-free biolimus-eluting stents (PF-BESs) versus ultrathin stents in unprotected left main (ULM) or bifurcation. BACKGROUND: PF-BESs due to reduced length of dual antiplatelet therapy (DAPT) are increasingly used. However, there are limited data about safety and efficacy for ULM or bifurcation. METHODS: We selected all-patients treated for ULM or bifurcation from two multicenter real life registries (RAIN [NCT03544294] evaluating ultrathin stents, CHANCE [NCT03622203] appraising PF-BES). After propensity score with matching, the primary endpoint was major adverse cardiac events (MACE; a composite of all-cause death, myocardial infarction, target lesion revascularization [TLR], and stent thrombosis [ST]), while its components along with target vessel revascularization (TVR) secondary endpoints. RESULTS: Three thousand and three patients treated with ultrathin stents and 446 with PF-BESs, resulting respectively in 562 and 281 after propensity score with matching (33 and 22%, respectively, with ULM disease). After 12 (8-20) months, rates of MACE were similar (9 vs. 8%, p = 0.56) without difference in TLR and ST (3.0 vs. 1.7%, p = .19 and 1.8 vs. 1.1%, p = .42). These results were consistent for ULM group (3 vs. 1.7% and 1.8 vs. 1.1%, p = .49 and .76), for non-ULM group (2.1 vs. 3.4%, p = .56 and 1.2 vs. 1.7%, p = .78) and for two-stent strategy (8.7 vs. 4.5% and 4.3 vs. 3.2%, p = .75 and .91). Among patients treated with 1 month of DAPT in both groups, those with ultrathin stents experienced higher rates of MACE related to all-cause death (22 vs. 12%, p = .04) with higher although not significant rates of ST (3 vs. 0%, p = .45). CONCLUSIONS: PF-BES implanted on ULM or BiF offered freedom from TLR and ST comparable to ultrathin stents. PF-BESs patients assuming DAPT for 1 month experienced a lower despite not significant incidence of ST.

20 Article Impact of Final Kissing Balloon and of Imaging on Patients Treated on Unprotected Left Main Coronary Artery With Thin-Strut Stents (From the RAIN-CARDIOGROUP VII Study). 2019

D'Ascenzo, Fabrizio / Omedè, Pierluigi / De Filippo, Ovidio / Cerrato, Enrico / Autelli, Michele / Trabattoni, Daniela / Ryan, Nicola / Venuti, Giuseppe / Muscoli, Saverio / Montabone, Andrea / Wojakowski, Wojciech / Rognoni, Andrea / Helft, Gerard / Gallo, Diego / Parma, Radoslaw / De Luca, Leonardo / Figini, Filippo / Mitomo, Satoru / Boccuzzi, Giacomo / Mattesini, Alessio / Wańha, Wojciech / Smolka, Grzegorz / Huczek, Zenon / Cortese, Bernardo / Sheiban, Imad / Escaned, Javier / Biolè, Carloalberto / Conrotto, Federico / Templin, Christian / Quadri, Giorgio / Rolfo, Cristina / Capodanno, Davide / Chieffo, Alaide / Nuñez-Gil, Ivan / Morbiducci, Umberto / Iannaccone, Mario / Gili, Sebastiano / Mario, Carlo di / Moretti, Claudio / D'Amico, Maurizio / Varbella, Ferdinando / Romeo, Francesco / Lüscher, Thomas F. ·Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy. Electronic address: fabrizio.dascenzo@gmail.com. · Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy. · Department of Cardiology, Infermi Hospital, Rivoli, Italy. · Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain. · Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. · Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy. · Department of Cardiology, S.G. Bosco Hospital, Torino, Italy. · Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland. · Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy. · Sorbonne Université, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France. · Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Torino, Italy. · Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy. · Pederzoli Hospital, Peschiera del Garda, Italy. · Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy. · Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. · Medical University of Warsaw, Warsaw, Poland. · Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy. · Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. · Unità Funzionale Interaziendale di Emodinamica, Ospedale degli Infermi di Rivoli e AOU San Luigi Gonzaga di Orbassano, Turin, Italy. · SS Annunziata Hospital, Cuneo, Italy. · Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom. ·Am J Cardiol · Pubmed #30846212.

ABSTRACT: Few data are available about the impact on outcomes of procedural strategies for percutaneous coronary intervention with thin-struts stents on unprotected left main (ULM): 792 patients with an ULM stenosis treated with percutaneous coronary intervention with thin-strut stents were enrolled in the present multicenter registry. Target lesion revascularization (TLR) was the primary end point. MACE (a composite of all-cause death, myocardial infarction, TLR, and stent thrombosis) and its single components, along with target vessel revascularization were the secondary end points. Subgroup analyses were performed according to complex versus noncomplex bifurcation lesions. After 16 months, 5.5% of patients experienced a TLR. At multivariate analysis, provisional stenting (odds ratio [OR] 0.46: 0.85 to 0.23, p = 0.006), use of imaging (OR 0.45: 0.23 to 0.98, p = 0.003) and final kissing balloon (FKB) (OR 0.41: 0.83 to 0.21, p = 0.001) reduced risk of TLR. FKB reduced risk of overall TLR only for 2 stents-strategy (6.2% vs 32.4%, p <0.05), but not for provisional strategy (3.8% vs 3.7%, p = 0.67). Intracoronary imaging reduced risk of overall TLR both for provisional (2.2% vs 5.4%) and for 2-stents strategy (7.3% vs 14.1% p <0.05 for both, all confidence interval 95%). In conclusion, TLR for ULM patients treated with thin-strut stents is infrequent. Provisional stenting was noninferior compared with 2-stents apart from complex lesions. Benefit from intracoronary imaging is consistent for different strategies, whereas that from FKB persists only for 2-stents.

21 Article Racial Differences in Ischaemia/Bleeding Risk Trade-Off during Anti-Platelet Therapy: Individual Patient Level Landmark Meta-Analysis from Seven RCTs. 2019

Kang, Jeehoon / Park, Kyung Woo / Palmerini, Tullio / Stone, Gregg W / Lee, Michael S / Colombo, Antonio / Chieffo, Alaide / Feres, Fausto / Abizaid, Alexandre / Bhatt, Deepak L / Valgimigli, Marco / Hong, Myeong-Ki / Jang, Yangsoo / Gilard, Martine / Morice, Marie-Claude / Park, Duk-Woo / Park, Seung-Jung / Jeong, Young-Hoon / Park, Jiesuck / Koo, Bon-Kwon / Kim, Hyo-Soo. ·Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. · Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, United States. · Division of Cardiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, United States. · San Raffaele Scientific Institute, Milan, Italy. · Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. · Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, United States. · Swiss Cardiovascular Center, Bern University Hospital, Bern University, Bern, Switzerland. · Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. · Department of Cardiology, Brest University, Brest, France. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. · Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. ·Thromb Haemost · Pubmed #30597509.

ABSTRACT: BACKGROUND:  Prolonged dual anti-platelet therapy (DAPT) is intended to reduce ischaemic events, at the cost of an increased bleeding risk in patients undergoing percutaneous coronary intervention (PCI). In this study, we evaluated whether race influences the ischaemia/bleeding risk trade-off. METHODS:  We searched for randomized clinical trials (RCTs) comparing DAPT duration after PCI. To compare the benefit or harm between DAPT duration by race, individual patient-level landmark meta-analysis was performed after discontinuation of the shorter duration DAPT group in each RCT. The primary ischaemic endpoint was major adverse cardiac events (MACEs), and the primary bleeding endpoint was major bleeding events (clinicaltrials.gov NCT03338335). RESULTS:  Seven RCTs including 16,518 patients (8,605 East Asians, 7,913 non-East Asians) were pooled. MACE occurred more frequently in non-East Asians (0.8% vs. 1.8%, CONCLUSION:  We suggest that the ischaemia/bleeding trade-off may be different between East Asians and non-East Asians. In East Asians, prolonged DAPT may have no effect in reducing the ischaemic risk, while significantly increases the bleeding risk.

22 Article New-generation drug-eluting stents for left main coronary artery disease according to the EXCEL trial enrollment criteria: Insights from the all-comers, international, multicenter DELTA-2 registry. 2019

Tanaka, Akihito / Giustino, Gennaro / Briede, Ieva / Sawaya, Fadi J / Daemen, Joost / Kawamoto, Hiroyoshi / Meliga, Emanuele / D'Ascenzo, Fabrizio / Cerrato, Enrico / Stefanini, Giulio G / Capodanno, Davide / Mangiameli, Andrea / Templin, Christian / Erglis, Andrejs / Morice, Marie Claude / Mehran, Roxana / Van Mieghem, Nicolas M / Nakamura, Sunao / De Benedictis, Mauro / Pavani, Marco / Varbella, Ferdinando / Pisaniello, Marco / Sharma, Samin K / Tamburino, Corrado / Tchetche, Didier / Colombo, Antonio / Chieffo, Alaide / Anonymous2121017. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America. · Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia. · Hopital privé Jacques Cartier, Ramsay Générale de Santé, Massy, France. · Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands. · Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. · Department of Cardiology, Mauriziano Hospital, Turin, Italy. · Department of Internal Medicine, Division of Cardiology, University of Turin, Città della Salute e della Scienza, Turin, Italy. · San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy. · Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. · C.A.S.T., P.O. Gaspare Rodolico, Azienda-Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy. · Clinique Pasteur, Toulouse, France. · University Hospital of Zurich, Zurich, Switzerland. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. ·Int J Cardiol · Pubmed #30595357.

ABSTRACT: BACKGROUND: Percutaneous coronary intervention (PCI) has been established as an alternative treatment option to coronary artery by-pass graft (CABG) surgery in patients with left main coronary artery disease (LMCAD). Whether the findings of randomized controlled trials are applicable to a real-world patient population is unclear. METHODS: We compared the outcomes of PCI with new-generation DES in the all-comer, international, multicenter DELTA-2 registry retrospectively evaluating mid-term clinical outcomes with the historical CABG cohort enrolled in the DELTA-1 registry according to the EXCEL key inclusion or exclusion criteria. The primary endpoint was the composite of death, myocardial infarction, or stroke at the median time of follow-up time of 501 days. The consistency of the effect of DELTA-2 PCI versus DELTA-1 CABG according to the EXCEL enrollment criteria was tested using propensity score-adjusted Cox regression models. RESULTS: Out of 3986 patients enrolled in the DELTA-2 PCI registry, 2418 were EXCEL candidates and 1568 were not EXCEL candidates. The occurrence of the primary endpoint was higher among non-EXCEL candidates compared with EXCEL candidates (15.4% vs. 6.9%; hazard ratio 2.52; 95% confidence interval 2.00-3.16; p < 0.001). Among 901 patients enrolled in the historical DELTA-1 CABG cohort, 471 were EXCEL candidates and 430 were not EXCEL candidates. When comparing the DELTA-2 PCI with the DELTA-1 CABG cohort, the occurrence of the primary endpoint was lower in the PCI group compared with the historical CABG cohort among EXCEL candidates (6.9% vs. 10.7%; adjusted hazard ratio: 0.65; 95% confidence interval: 0.45-0.92), while no significant difference was observed among non-EXCEL candidates (15.4% vs. 12.5%; adjusted hazard ratio: 0.94; 95% confidence interval: 0.67-1.33) with evidence of statistical interaction (adjusted interaction p-value = 0.002). CONCLUSIONS: In a real-world population, PCI can be selected more favorably as an alternative to CABG in patients fulfilling the enrollment criteria of the EXCEL trial.

23 Article Mid-term outcomes after percutaneous interventions in coronary bifurcations. 2019

Zimarino, Marco / Briguori, Carlo / Amat-Santos, Ignacio J / Radico, Francesco / Barbato, Emanuele / Chieffo, Alaide / Cirillo, Plinio / Costa, Ricardo A / Erglis, Andrejs / Gamra, Habib / Gil, Robert J / Kanic, Vojko / Kedev, Sasko A / Maddestra, Nicola / Nakamura, Sunao / Pellicano, Mariano / Petrov, Ivo / Strozzi, Maja / Tesorio, Tullio / Vukcevic, Vladan / De Caterina, Raffaele / Stankovic, Goran / Anonymous481027. ·Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy; Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy. Electronic address: m.zimarino@unich.it. · Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy. · CIBERCV, Hospital Clínico Universitario de Valladolid, Spain. · Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy. · Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. · Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. · Cardiology Department, Fattouma Bourguiba Hospital, University of Monastir, Tunisia. · Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland. · Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia. · University Clinic of Cardiology Skopje, Skopje, Macedonia. · Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy. · Department of Cardiology, New Tokyo Hospital, Chiba, Japan. · Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy. · City Clinic, Sofia, Bulgaria. · Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia. · Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy. · Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Serbia. ·Int J Cardiol · Pubmed #30528620.

ABSTRACT: BACKGROUND: The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated. METHODS: Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected. RESULTS: Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 0.05) as additional independent predictors of MACE. CONCLUSIONS: Beyond traditional risk factors, multivessel disease, the length of the SB lesion, "bail-out" stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.

24 Article Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries. 2019

Caixeta, Adriano / Campos, Carlos M / Felix, Cordula / Chieffo, Alaide / Capranzano, Piera / Kawamoto, Hiroyoshi / Tamburino, Claudia / Diletti, Roberto / de Ribamar Costa, José / Onuma, Yoshinobu / van Geuns, Robert-Jan / Bartorelli, Antonio L / Colombo, Antonio / Tamburino, Corrado / Serruys, Patrick W / Abizaid, Alexandre. ·Hospital Israelita Albert Einstein, São Paulo, Brazil. ·EuroIntervention · Pubmed #30375335.

ABSTRACT: AIMS: The aim of this study was to investigate the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS: We pooled patient-level databases derived from the large-scale ABSORB EXTEND study and five high-volume international centres. Between November 2011 and November 2015, 1,933 patients underwent PCI with a total of 2,372 Absorb BVS implanted. The median age was 61.0 (IQR 53.0 to 68.6) years, 24% had diabetes, and 68.2% presented with stable coronary artery disease. At a median follow-up of 616 days, MACE occurred in 93 (4.9%) patients, all-cause death in 36 (1.9%) patients, myocardial infarction in 47 (2.5%) patients, and target vessel revascularisation in 72 (3.8%) patients. Definite or probable scaffold thrombosis occurred in 26 (1.3%) patients. On multivariable logistic regression analysis, acute coronary syndromes (hazard ratio [HR] 2.79, 95% confidence interval [CI]: 1.47 to 5.29; p=0.002), dyslipidaemia (HR 1.43, 95% CI: 1.23 to 1.79; p=0.007), scaffold/reference diameter ratio >1.25 (HR 1.49, 95% CI: 1.18 to 1.88; p=0.001), and residual stenosis >15% (HR 1.67, 95% CI: 1.34 to 2.07; p<0.001) were independent predictors of MACE, whereas the use of intravascular imaging was independently associated with a reduction in MACE (HR 0.13, 95% CI: 0.06 to 0.28; p<0.001). CONCLUSIONS: Optimal Absorb BVS implantation and the use of intravascular imaging guidance are associated with lower rates of adverse events at long-term follow-up.

25 Article New-Generation Drug-Eluting Stents for Left Main In-Stent Restenosis: The DELTA-2 Registry. 2018

Giustino, Gennaro / Tanaka, Akihito / Erglis, Andrejs / Morice, Marie Claude / Van Mieghem, Nicolas M / Meliga, Emanuele / D'Ascenzo, Fabrizio / Stefanini, Giulio G / Capodanno, Davide / Chieffo, Alaide / Anonymous6440971. · ·JACC Cardiovasc Interv · Pubmed #30522680.

ABSTRACT: -- No abstract --

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