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Coronary Artery Disease: HELP
Articles by Alaide Chieffo
Based on 96 articles published since 2008
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Between 2008 and 2019, A. Chieffo wrote the following 96 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 / Anonymous4720754. ·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 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 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.

15 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.

16 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 --

17 Review Bioabsorbable and biocompatible stents. Is a new revolution coming? 2008

Rogacka, R / Chieffo, A / Latib, A / Colombo, A. ·Desio Hospital, Desio, Milan, Italy. ·Minerva Cardioangiol · Pubmed #18813184.

ABSTRACT: With the introduction of drug-eluting stents (DES) the problem of restenosis after percutaneous stent implantation was partially resolved. In the first generation of DES a stainless steel platform was coated with a durable polymer eluting and controlling the release of an active restenotic drug. The impairment of re-endothelization after DES implantation, one of the causes of late stent thrombosis, was to some extent attributed to the properties of the durable polymer and/or drug that it eluted. The introduction of biodegradable platforms and biocompatible polymers may potentially address this issue. Modern technologies are being applied to improve the characteristics of biodegradable stents and find new active pharmacological agents or combinations of standard antirestenotic and antithrombotic drugs that can be eluted from the stents, in order to improve their safety profile and clinical utility.

18 Review A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease. 2008

Biondi-Zoccai, Giuseppe G L / Lotrionte, Marzia / Moretti, Claudio / Meliga, Emanuele / Agostoni, Pierfrancesco / Valgimigli, Marco / Migliorini, Angela / Antoniucci, David / Carrié, Didier / Sangiorgi, Giuseppe / Chieffo, Alaide / Colombo, Antonio / Price, Matthew J / Teirstein, Paul S / Christiansen, Evald H / Abbate, Antonio / Testa, Luca / Gunn, Julian P G / Burzotta, Francesco / Laudito, Antonio / Trevi, Gian Paolo / Sheiban, Imad. ·Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy. gbiondizoccai@gmail.com ·Am Heart J · Pubmed #18215597.

ABSTRACT: BACKGROUND: Cardiac surgery is the standard treatment for unprotected left main disease (ULM). Drug-eluting stent (DES) implantation has been recently reported in patients with ULM but with unclear results. We systematically reviewed outcomes of percutaneous DES implantation in ULM. METHODS: Several databases were searched for clinical studies reporting on > or = 20 patients and > or = 6-month follow-up. The primary end point was major adverse cardiovascular events (MACEs; ie, death, myocardial infarction, or target vessel revascularization [TVR]) at the longest follow-up. Incidence and adjusted risk estimates were pooled with generic inverse variance random-effect methods (95% CIs). RESULTS: From 823 initial citations, 16 studies were included (1278 patients, median follow-up 10 months). Eight were uncontrolled registries, 5 nonrandomized comparisons between DES and bare-metal stents and 3 nonrandomized comparisons between DES and CABG, with no properly randomized trial. Meta-analysis for DES-based PCI showed, at the longest follow-up, rates of 16.5% (11.7%-21.3%) MACE, 5.5% (3.4%-7.7%) death, and 6.5% (3.7%-9.2%) TVR. Comparison of DES versus bare-metal stent disclosed adjusted odds ratios for MACE of 0.34 (0.16-0.71), and DES versus CABG showed adjusted odds ratios for MACE plus stroke of 0.46 (0.24-0.90). Meta-regression showed that disease location predicted MACE (P = .001) and TVR (P = .020), whereas high-risk features predicted death (P = .027). CONCLUSIONS: Clinical studies report apparently favorable early and midterm results in selected patients with ULM. However, given their limitations in validity and the inherent risk for DES thrombosis, results from randomized trials are still needed to definitely establish the role of DES implantation instead of the reference treatment, surgery.

19 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.

20 Article Long-Term Outcomes of Different Two-Stent Techniques With Second-Generation Drug-Eluting Stents for Unprotected Left Main Bifurcation Disease: Insights From the FAILS-2 Study. 2018

Pavani, Marco / Conrotto, Federico / Cerrato, Enrico / D'Ascenzo, Fabrizio / Kawamoto, Hiroyoshi / Núñez-Gil, Ivan J / Pennone, Mauro / Garbo, Roberto / Tomassini, Francesco / Colombo, Francesco / Scacciatella, Paolo / Varbella, Ferdinando / Chieffo, Alaide / Colombo, Antonio / Escaned, Javier. ·Division of Cardiology, Città della Salute e della Scienza di Torino, Italy. marcopavani@alice.it. Website: www.cardiogroup.org. ·J Invasive Cardiol · Pubmed #30068784.

ABSTRACT: OBJECTIVES: To investigate the long-term clinical outcomes of second-generation drug-eluting stent (2G-DES) implantation for the treatment of complex unprotected left main coronary artery (ULMCA) bifurcation lesions with different two-stent techniques. BACKGROUND: Several two-stent techniques for ULMCA bifurcation lesions have been described. However, a paucity of data exists regarding the optimal strategy, especially in the 2G-DES era. METHODS: The FAILS-2 registry enrolled 1270 consecutive patients treated for ULMCA stenosis with 2G-DES. We compared long-term outcomes of different two-stent strategies in patients who underwent PCI for complex ULMCA bifurcation disease. The primary endpoints were the incidence of death and major adverse cardiac events (MACE, defined as a composite of all-cause death, myocardial infarction [MI], target-lesion revascularization [TLR], and stent thrombosis [ST]) at long-term follow-up. RESULTS: A total of 238 patients were included in the present analysis. T-stenting strategy was used in 66 patients, mini-crush in 104 patients, and culotte in 68 patients. After a median follow-up of 2.27 years, death rates were comparable for the three techniques (9.3% T-stenting vs 9.0% mini-crush vs 4.5% culotte [P=.48]). MACE rates were also similar between the three groups (22% T-stenting vs 26% mini-crush vs 31% culotte [P=.50]). Finally, we showed no differences in MI, ST, and TLR rates between groups. At multivariate analysis, no significant advantage of one technique over the others was observed. CONCLUSION: T-stenting, mini-crush, and culotte techniques using 2G-DES for ULMCA bifurcation disease showed similar clinical outcomes at long-term follow-up. MACE rates were mainly driven by in-stent restenosis at the circumflex ostium.

21 Article Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry. 2018

Mitomo, Satoru / Jabbour, Richard J / Mangieri, Antonio / Ancona, Marco / Regazzoli, Damiano / Tanaka, Akihito / Giannini, Francesco / Carlino, Mauro / Montorfano, Matteo / Chieffo, Alaide / Latib, Azeem / Colombo, Antonio. ·Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. · Department of Cardiology, Imperial College London, United Kingdom. · Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: info@emocolumbus.it. ·Int J Cardiol · Pubmed #29685691.

ABSTRACT: BACKGROUND: Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. METHODS: From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis > 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). RESULTS: A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. CONCLUSIONS: Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.

22 Article Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative. 2018

Chandrasekhar, Jaya / Baber, Usman / Sartori, Samantha / Stefanini, Giulio G / Sarin, Michele / Vogel, Birgit / Farhan, Serdar / Camenzind, Edoardo / Leon, Martin B / Stone, Gregg W / Serruys, Patrick W / Wijns, William / Steg, Philippe G / Weisz, Giora / Chieffo, Alaide / Kastrati, Adnan / Windecker, Stephan / Morice, Marie-Claude / Smits, Pieter C / von Birgelen, Clemens / Mikhail, Ghada W / Itchhaporia, Dipti / Mehta, Laxmi / Kim, Hyo-Soo / Valgimigli, Marco / Jeger, Raban V / Kimura, Takeshi / Galatius, Søren / Kandzari, David / Dangas, George / Mehran, Roxana. ·The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. · Humanitas Research Hospital, Rozzano, Milan, Italy. · Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre-lès-Nancy, France. · Columbia University Medical Center, New York, New York. · Imperial College Healthcare NHS Trust, London, United Kingdom. · Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium. · Département Hospitalo Universitaire, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France. · Columbia University Medical Center, New York, New York; Shaare Zedek Medical Center, Jerusalem, Israel. · San Raffaele Scientific Institute, Milan, Italy. · Deutsches Herzentrum Munchen, Technische Universitat Munich, Germany. · Bern University Hospital, Bern, Switzerland. · Institut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, Massy, France. · Maasstad Hospital, Rotterdam, the Netherlands. · Thoraxcentrum Twente, Enschede, the Netherlands. · Hoag Memorial Hospital Presbyterian, Newport Beach, California. · Ohio State University Medical Center, Columbus, Ohio. · Seoul National University Hospital, Seoul, Korea. · University of Ferrara, Ferrara, Italy. · University Hospital Basel, Basel, Switzerland. · Kyoto University Graduate School of Medicine, Kyoto, Japan. · Bispebjerg University Hospital, Copenhagen, Denmark. · Piedmont Heart Institute, Atlanta, Georgia. · The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org. ·JACC Cardiovasc Interv · Pubmed #29301648.

ABSTRACT: OBJECTIVES: The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). BACKGROUND: In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. METHODS: Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization. RESULTS: In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI. CONCLUSIONS: In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis.

23 Article Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study. 2018

Kawamoto, Hiroyoshi / Chieffo, Alaide / D'Ascenzo, Fabrizio / Jabbour, Richard J / Naganuma, Toru / Cerrato, Enrico / Ugo, Fabrizio / Pavani, Marco / Varbella, Ferdinando / Boccuzzi, Giacomo / Pennone, Mauro / Garbo, Roberto / Conrotto, Federico / Biondi-Zoccai, Giuseppe / D'Amico, Maurizio / Moretti, Claudio / Escaned, Javier / Gaita, Fiorenzo / Nakamura, Sunao / Colombo, Antonio. ·IRCCS Ospedale San Raffaele, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; New Tokyo Hospital, Matsudo, Japan. · IRCCS Ospedale San Raffaele, Milan, Italy. · Citta della Salute e della Scienza, Turin, Italy. · IRCCS Ospedale San Raffaele, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy. · New Tokyo Hospital, Matsudo, Japan. · Ospedale degli Infermi Rivoli, Turin, Italy. · Ospedale San Giovanni Bosco, Turin, Italy. · Sapienza University of Rome, Latina, Italy. · Hospital San Carlos, Madrid, Spain. · IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: info@emocolumbus.it. ·Int J Cardiol · Pubmed #28992999.

ABSTRACT: BACKGROUND: This study sought to investigate the optimal percutaneous coronary intervention (PCI) strategy for true unprotected left main coronary artery (ULMCA) bifurcations. METHODS: The FAILS-2 was a retrospective multi-center study including patients with ULMCA disease treated with second-generation drug-eluting stents. Of these, we compared clinical outcomes of a provisional strategy (PS; n=216) versus an elective two-stent strategy (E2S; n=161) for true ULMCA bifurcations. The primary endpoint was the incidence of major adverse cardiac events (MACEs) at 3-years. We further performed propensity-score adjustment for clinical outcomes. RESULTS: There were no significant differences between the groups in terms of patient and lesion characteristics. 9.7% of patients in the PS group crossed over to a provisional two-stent strategy. MACEs were not significantly different between groups (MACE at 3-year; PS 28.1% vs. E2S 28.9%, adjusted p=0.99). The rates of target lesion revascularization (TLR) on the circumflex artery (LCX) were numerically high in the E2S group (LCX-TLR at 3-years; PS 11.8% vs. E2S 16.6%, adjusted p=0.51). CONCLUSIONS: E2S was associated with a comparable MACE rate to PS for true ULMCA bifurcations. The rates of LCX-TLR tended to be higher in the E2S group although there was no statistical significance. CONDENSED ABSTRACT: This study sought to compare the clinical outcomes of a provisional strategy (PS) with an elective two-stent strategy (E2S) for the treatment of true unprotected left main coronary artery bifurcations. 377 Patients (PS 216 vs. E2S 161 patients) were evaluated, and 9.7% in the PS group crossed over to a two-stent strategy. E2S was associated with a similar major adverse cardiac event rate at 3-years when compared to the PS strategy (PS 28.1% vs. E2S 28.9%, p=0.99). However, the left circumflex artery TLR rate at 3-year tended to be higher in the E2S group (PS 11.8% vs. E2S 16.6%, p=0.51).

24 Article The DELTA 2 Registry: A Multicenter Registry Evaluating Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents in Patients With Obstructive Left Main Coronary Artery Disease. 2017

Chieffo, Alaide / 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 / Anonymous531032. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Mount Sinai Medical Center, New York, New York. · Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. · Institut Hospitalier 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. · Ferrarotto Hospital, University of Catania, Catania, Italy. · Clinique Pasteur, Toulouse, France. · University Hospital of Zurich, Zurich, Switzerland. ·JACC Cardiovasc Interv · Pubmed #29217002.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate clinical outcomes of unprotected left main coronary artery percutaneous coronary intervention (PCI) with new-generation drug-eluting stents in a "real world" population. BACKGROUND: PCI of the unprotected left main coronary artery is currently recommended as an alternative to coronary artery bypass grafting (CABG) in selected patients. METHODS: All consecutive patients with unprotected left main coronary artery stenosis treated by PCI with second-generation drug-eluting stents were analyzed in this international, all-comers, multicenter registry. The results were compared with those from the historical DELTA 1 (Drug Eluting Stent for Left Main Coronary Artery) CABG cohort using propensity score stratification. The primary endpoint was the composite of death, myocardial infarction (MI), or stroke at the median time of follow-up. RESULTS: A total of 3,986 patients were included. The mean age was 69.6 ± 10.9 years, diabetes was present in 30.8%, and 21% of the patients presented with acute MI. The distal left main coronary artery was involved in 84.6% of the lesions. At a median of 501 days (≈17 months) of follow-up, the occurrence of the primary endpoint of death, MI, or cerebrovascular accident was lower in the PCI DELTA 2 group compared with the historical DELTA 1 CABG cohort (10.3% vs. 11.6%; adjusted hazard ratio: 0.73; 95% confidence interval: 0.55 to 0.98; p = 0.03). Of note, an advantage of PCI was observed with respect to cerebrovascular accident (0.8% vs. 2.0%; adjusted hazard ratio: 0.37; 95% confidence interval: 0.16 to 0.86; p = 0.02), while an advantage of CABG was observed with respect to target vessel revascularization (14.2% vs. 2.9%; adjusted hazard ratio: 3.32; 95% confidence interval: 2.12 to 5.18; p < 0.0001). CONCLUSIONS: After a median follow-up period of 17 months, PCI with new-generation drug-eluting stents was associated with an overall low rate of the composite endpoint of death, MI, or cerebrovascular accident.

25 Article White Blood Cell Count and Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the PARIS Study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry). 2017

Shah, Binita / Baber, Usman / Pocock, Stuart J / Krucoff, Mitchell W / Ariti, Cono / Gibson, C Michael / Steg, Philippe Gabriel / Weisz, Giora / Witzenbichler, Bernhard / Henry, Timothy D / Kini, Annapoorna S / Stuckey, Thomas / Cohen, David J / Iakovou, Ioannis / Dangas, George / Aquino, Melissa B / Sartori, Samantha / Chieffo, Alaide / Moliterno, David J / Colombo, Antonio / Mehran, Roxana. ·From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.) · Department of Medicine (Cardiology), New York University School of Medicine (B.S.) · Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.) · Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.) · Department of Medicine (Cardiology), Duke University School of Medicine, Durham, NC (M.W.K.) · Department of Medicine (Cardiology), Harvard Medical School, Cambridge, MA (C.M.G.) · Department of Medicine (Cardiology), Hôpital Bichat-Claude Bernard, Paris, France (P.G.S.) · Department of Medicine (Cardiology), Columbia University Medical Center, New York, NY (G.W.) · Department of Medicine (Cardiology), HELIOS Amper-Klinikum Dachau, Germany (B.W.) · Department of Medicine (Cardiology), Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.) · Department of Medicine (Cardiology), Minneapolis Heart Institute Foundation, University of Minnesota (T.D.H.) · Department of Medicine (Cardiology), Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, NC (T.S.) · Department of Medicine (Cardiology), St Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.) · Department of Medicine (Cardiology), Onassis Cardiac Surgery Center, Athens, Greece (I.I.) · Department of Medicine (Cardiology), San Raffaele Hospital, Milan, Italy (A. Chieffo, A. Colombo) · and Department of Medicine (Cardiology), University of Kentucky, Lexington (D.J.M.). ·Circ Cardiovasc Interv · Pubmed #28916600.

ABSTRACT: BACKGROUND: Elevated white blood cell (WBC) count is associated with increased major adverse cardiovascular events (MACE) in the setting of acute coronary syndrome. The aim of this study was to evaluate whether similar associations persist in an all-comers population of patients undergoing percutaneous coronary intervention in the contemporary era. METHODS AND RESULTS: In the multicenter, prospective, observational PARIS study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry), 4222 patients who underwent percutaneous coronary intervention in the United States and Europe between July 1, 2009, and December 2, 2010, were evaluated. The associations between baseline WBC and MACE (composite of cardiac death, stent thrombosis, spontaneous myocardial infarction, or target lesion revascularization) at 24-month follow-up were analyzed using multivariable Cox regression. Patients with higher WBC were more often younger, smokers, and with less comorbid risk factors compared with those with lower WBC. After adjustment for baseline and procedural characteristics, WBC remained independently associated with MACE (hazard ratio [HR] per 10 CONCLUSIONS: Increased WBC is an independent predictor of MACE after percutaneous coronary intervention in a contemporary all-comers cohort. Further studies to delineate the underlying pathophysiologic role of elevated WBC across a spectrum of coronary artery disease presentations are warranted. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00998127.

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