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Coronary Artery Disease: HELP
Articles by Héctor M. García-García
Based on 16 articles published since 2008
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Between 2008 and 2019, Héctor M. García-García wrote the following 16 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Tissue characterisation using intravascular radiofrequency data analysis: recommendations for acquisition, analysis, interpretation and reporting. 2009

García-García, Héctor M / Mintz, Gary S / Lerman, Amir / Vince, D Geoffrey / Margolis, M Paulina / van Es, Gerrit-Anne / Morel, Marie-Angèle M / Nair, Anuja / Virmani, Renu / Burke, Allen P / Stone, Gregg W / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #20449928.

ABSTRACT: This document suggests standards for the acquisition, measurement, and reporting of radiofrequency data analysis (virtual histology - VH) intravascular ultrasound (IVUS) studies. Readers should view this document as the authors' best attempt in an area of rapidly evolving investigation, an area where rigorous evidence is not yet available or widely accepted. Nevertheless, this document is based on known pathologic data as well as previously reported imaging data; where practical, this data is summarised in the current document, a document which will also include recommendations for future evolution of the technology.

2 Review Diagnosis and treatment of coronary vulnerable plaques. 2008

García-García, Héctor M / Gonzalo, Nieves / Granada, Juan F / Regar, Evelyn / Serruys, Patrick W. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·Expert Rev Cardiovasc Ther · Pubmed #18248275.

ABSTRACT: Thin-capped fibroatheroma is the morphology that most resembles plaque rupture. Detection of these vulnerable plaques in vivo is essential to being able to study their natural history and evaluate potential treatment modalities and, therefore, may ultimately have an important impact on the prevention of acute myocardial infarction and death. Currently, conventional grayscale intravascular ultrasound, virtual histology and palpography data are being collected with the same catheter during the same pullback. A combination of this catheter with either thermography capability or additional imaging, such as optical coherence tomography or spectroscopy, would be an exciting development. Intravascular magnetic resonance imaging also holds much promise. To date, none of the techniques described above have been sufficiently validated and, most importantly, their predictive value for adverse cardiac events remains elusive. Very rigorous and well-designed studies are compelling for defining the role of each diagnostic modality. Until we are able to detect in vivo vulnerable plaques accurately, no specific treatment is warranted.

3 Clinical Trial Changes of coronary plaque composition correlate with C-reactive protein levels in patients with ST-elevation myocardial infarction following high-intensity statin therapy. 2016

Koskinas, Konstantinos C / Zaugg, Serge / Yamaji, Kyohei / García-García, Héctor M / Taniwaki, Masanori / Klingenberg, Roland / Moschovitis, Aris / Lüscher, Thomas F / van Tits, Lambertus J / Matter, Christian M / Windecker, Stephan / Räber, Lorenz. ·Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Clinical Trials Unit, Bern University, Bern, Switzerland. · Interventional Cardiology, Washington Hospital Center, Washington DC, USA. · Cardiology Department, University Hospital Zurich, Zurich, Switzerland. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: lorenz.raeber@insel.ch. ·Atherosclerosis · Pubmed #26921743.

ABSTRACT: OBJECTIVES: Levels of inflammatory biomarkers associate with changes of coronary atheroma burden in statin-treated patients with stable coronary artery disease. This study sought to determine changes of plaque composition in vivo in relation to high-sensitivity C-reactive protein (hs-CRP) levels in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin therapy. METHODS: The IBIS-4 study performed serial (baseline and 13-month), 2-vessel intravascular ultrasound (IVUS) and radiofrequency-IVUS of the non-infarct-related arteries in patients with STEMI treated with high-intensity statin therapy. The present analysis included 44 patients (80 arteries) with serial measurements of hs-CRP. RESULTS: At follow-up, median low-density lipoprotein cholesterol (LDL-C) levels decreased from 126 to 77 mg/dl, HDL-C increased from 44 to 47 mg/dl, and hs-CRP decreased from 1.6 to 0.7 mg/L. Regression of percent atheroma volume (-0.99%, 95% CI -1.84 to -0.14, p = 0.024) was accompanied by reduction of percent fibro-fatty (p = 0.04) and fibrous tissue (p < 0.001), and increase in percent necrotic core (p = 0.006) and dense calcium (p < 0.001). Follow-up levels of hs-CRP, but not LDL-C, correlated with changes in percent necrotic core (p = 0.001) and inversely with percent fibrous tissue volume (p = 0.008). Similarly, baseline-to-follow-up change of hs-CRP correlated with the change in percent necrotic core volume (p = 0.02). CONCLUSIONS: In STEMI patients receiving high-intensity statin therapy, stabilization of VH-IVUS-defined necrotic core was confined to patients with lowest on-treatment levels and greatest reduction of hs-CRP. Elevated CRP levels at follow-up may identify progression of high-risk coronary plaque composition despite intensive statin therapy and overall regression of atheroma volume.

4 Clinical Trial Differential impact of five coronary devices on plaque size: insights from the ABSORB and SPIRIT trials. 2014

García-García, Héctor M / Serruys, Patrick W / Campos, Carlos M / Onuma, Yoshinobu. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; Cardialysis, Rotterdam, The Netherlands. Electronic address: hect2701@gmail.com. · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. ·Int J Cardiol · Pubmed #25017907.

ABSTRACT: BACKGROUND: Coronary plaque size modification, by either local (device) or systemic treatments, has been the target for many years. METHODS: From ABSORB Cohort A (Absorb BVS 1.0), ABSORB Cohort B (Absorb BVS 1.1), SPIRIT FIRST (Multi-Link Vision vs. Xience V) & SPIRIT II (Xience V vs. Taxus), we calculated the total plaque area (vessel minus lumen area - thus it comprises both compartments - the plaque behind struts and the neointima.) changes by IVUS. RESULTS: A total of 313 patients were included. Comparison-at-6-month follow-up: All devices induced an increase in the total plaque area. The largest increase occurred with Vision and Taxus stents as compared to other devices [Absorb BVS (1.0 and 1.1) and Xience V], (p=0.0002). Comparison-at-2-year follow-up: Absorb BVS 1.1 had a larger increase from post procedure in total plaque compared to Absorb BVS 1.0, Xience V and Taxus (p=0.0499). However, in Absorb BVS 1.1 total plaque showed a reduction of 2.2% from 1 to 3 years. Specifically, the total plaque in the sequential cohorts of Absorb BVS 1.1 increased 16.2% from baseline to 2 years (Cohort B1) while at 3 years this increase is only 5% compared to baseline (Cohort B2). CONCLUSIONS: Local devices affect coronary plaque size differently and it depends on the platform (metallic vs. polymeric) and on whether it is a bare - or drug eluting stent. Coronary scaffolds appear to be a promising alternative to metallic stents since they allow plaque regression at long-term follow-up.

5 Clinical Trial A comparison of the distribution of necrotic core in bifurcation and non-bifurcation coronary lesions: an in vivo assessment using intravascular ultrasound radiofrequency data analysis. 2010

García-García, Héctor M / Gomez-Lara, Josep / Gonzalo, Nieves / Garg, Scot / Shin, Eun Seok / Goedhart, Dick / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. h.garciagarcia@erasmusmc.nl ·EuroIntervention · Pubmed #20884409.

ABSTRACT: AIMS: High-risk plaques are prone to develop at the site of coronary vessel bifurcations. The distribution of necrotic core at bifurcation lesions (BL) is known, however, little has been described on the necrotic core distribution in non-BLs. Therefore we compared the distribution of necrotic core between BL and non-BLs in coronary arteries using IVUS-VH imaging. METHODS AND RESULTS: A total of 129 patients (112 non-BL and 108 BL) were included. The lesions were divided into upstream and downstream segments according the location of the minimum lumen area (MLA) within the plaque. In BLs, compositional analysis showed no differences between the three segments. The necrotic core in contact with the lumen that was located in the downstream segment was significantly larger. While in non-BLs, this was not significantly different between segments. Plaque burden in BLs was 56.60±5.79% vs. 55.50±4.54% in non-BLs, p=0.04. Mean necrotic core area was larger in BLs 0.84±0.55mm2 vs. 0.70±0.49mm2, p=0.048. Mean percentage necrotic core was 15.48±8.02% vs. 14.51±7.64%, p=0.37. There was a trend towards a greater content of necrotic core in contact with the lumen in BLs. The percentage of frames with a major confluent pool of necrotic core in contact with the lumen >10% in BLs was 11.78±17.18 vs. 8.95±17.86 in non-BLs, p=0.065. There was a statistically significant difference in the frequency of IVUS derived thin capped fibroatheromas between bifurcation lesions 20 vs. 13 in non-bifurcation lesions, p=0.03. CONCLUSIONS: Bifurcation lesions appear to have a larger plaque burden with a different plaque composition compared to non-bifurcation lesions. This may partly explain the adverse outcomes seen following treatment of bifurcation lesions in contemporary practice.

6 Clinical Trial In vivo evaluation of stent strut distribution patterns in the bioabsorbable everolimus-eluting device: an OCT ad hoc analysis of the revision 1.0 and revision 1.1 stent design in the ABSORB clinical trial. 2010

Okamura, Takayuki / Garg, Scot / Gutiérrez-Chico, Juan Luis / Shin, Eun-Seok / Onuma, Yoshinobu / García-García, Héctor M / Rapoza, Richard J / Sudhir, Krishnankutty / Regar, Evelyn / Serruys, Patrick W. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #20542778.

ABSTRACT: AIMS: The ABSORB Cohort A clinical study has shown the feasibility and safety of the fully bioabsorbable everolimus-eluting structure (BVS, revision 1.0). However, the study also demonstrated somewhat higher acute and late recoil with the BVS structure compared to metallic drug eluting stents. Based on these clinical observations, modifications to the stent design (BVS, revision 1.1) were introduced for the ABSORB Cohort B study in order to decrease recoil. The aim was to compare in vivo the strut distribution between the BVS revision 1.0 (Cohort A), and BVS revision 1.1 (Cohort B) designs. METHODS AND RESULTS: OCT analysis was performed by two independent analysts in four patients from each cohort of the ABSORB study. Strut distribution was assessed in cross-section, and longitudinally in a frameby-frame analysis. Variables recorded included inter-strut angle, maximum inter-strut angle and number of frames with < or =3 struts. The inter-observer correlation coefficient was also assessed. For both designs, on a patient level there was no significant difference in the number of analysed struts corrected for the length of the scaffold (p=0.78). Likewise, on a frame by frame analysis mean stent area, number of struts per frame, mean maximum inter-strut angle, and mean inter-strut angle were similar for both groups. However, in both structures there was a cyclical variation in the maximum number of struts per frame. The frequency of this variation was significantly higher in Cohort B. The inter-observer correlation coefficient for strut counts, inter-strut angle and maximum inter-strut angle was 0.91, 0.87 and 0.74 respectively. CONCLUSIONS: This ad hoc analysis confirms that the revision 1.1 BVS design has a different longitudinal strut distribution to the revision 1.0 BVS design, indicating that the new design has a reduced maximum circular unsupported cross sectional area.

7 Clinical Trial Assessment of the absorption process following bioabsorbable everolimus-eluting stent implantation: temporal changes in strain values and tissue composition using intravascular ultrasound radiofrequency data analysis. A substudy of the ABSORB clinical trial. 2009

García-García, Héctor M / Gonzalo, Nieves / Pawar, Ravindra / Kukreja, Neville / Dudek, Dariusz / Thuesen, Leif / Ormiston, John A / Regar, Evelyn / Serruys, Patrick W. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #19284065.

ABSTRACT: AIMS: The main objective was to use IVUS-backscatter radiofrequency (IVUS-RF) to assess the degradation of a bioabsorbable stent by measuring serial changes in dense calcium (DC) and necrotic core (NC) as assessed by intravascular ultrasound-Virtual Histology (IVUS-VH) and in the strain as assessed by palpography. METHODS AND RESULTS: In the ABSORB trial, 27 patients treated with a single bioabsorbable everolimus-eluting stent (BVS, Abbott Vascular, Santa Clara, CA, USA) were all imaged with IVUS-RF post-stenting and at 6-month follow-up, and 13 and 12 patients were also investigated pre-stenting with IVUS-VH and palpography respectively. From pre- to post-stenting, with VH (n = 13), there was an increase in mean "DC" (9.8 vs. 25.4%, p = 0.0002) and "NC" (15.5 vs. 30.5%, p = 0.0002). In palpography (n = 12), the mean number of frames with Rotterdam Classification (ROC) III/IV per cm decreased from 1.22 +/- 1.91 to 0.12 +/- 0.31 (p = 0.0781) and the mean cumulative strain values (all frames with ROC I-IV scores) changed from 0.50 +/- 0.27 to 0.20 +/- 0.10% (p = 0.0034). Comparing post-stenting with follow-up (n = 27), VH showed a decrease in "DC" (29.7% vs. 21.1%, p = 0.0001). "NC" also decreased (26.9 vs. 21.5%, p = 0.0027). For palpography (n = 25 patients), an increase in the mean number of frames with ROC III/IV per cm was observed from 0.09 +/- 0.26 to 0.22 +/- 0.36 (p = -0.1563) while the mean cumulative strain values (all frames with ROC I-IV scores) changed from 0.15 +/- 0.10 to 0.26 +/- 0.12% (p < 0.0001). CONCLUSIONS: IVUS-VH changes at 6 months suggest alteration of the BVS with reduction of RF backscattering by polymeric struts. Strained plaques on the palpograms were almost abolished following stent implantation. However, strain values reappeared within 6 months suggesting an increase in endoluminal deformability of the stented vessel.

8 Article High-sensitivity Troponin T in relation to coronary plaque characteristics in patients with stable coronary artery disease; results of the ATHEROREMO-IVUS study. 2016

Oemrawsingh, Rohit M / Cheng, Jin M / García-García, Héctor M / Kardys, Isabella / van Schaik, Ron H N / Regar, Evelyn / van Geuns, Robert-Jan / Serruys, Patrick W / Boersma, Eric / Akkerhuis, K Martijn. ·Thoraxcenter, Department of Cardiology, ErasmusMC and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands; Netherlands Heart Institute/Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Thoraxcenter, Department of Cardiology, ErasmusMC and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands. · Cardialysis BV, Rotterdam, The Netherlands; Washington Hospital Center, Department of Cardiology, Washington DC, United States. · Department of Clinical Chemistry, ErasmusMC, Rotterdam, The Netherlands. · Thoraxcenter, Department of Cardiology, ErasmusMC and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands. Electronic address: h.boersma@erasmusmc.nl. ·Atherosclerosis · Pubmed #26917225.

ABSTRACT: BACKGROUND AND AIMS: To assess the relationship between the extent and phenotype of coronary atherosclerosis, as assessed by in-vivo grayscale and radiofrequency intravascular ultrasound (IVUS), and circulating Troponin levels in patients with established stable coronary artery disease (CAD). METHODS: In this single-center, cross-sectional analysis, high-sensitivity Troponin T (hsTnT) was measured and IVUS was performed in a predefined non-stenotic segment of a non-culprit coronary artery in 231 patients with stable CAD undergoing elective angiography. RESULTS: HsTnT was detectable (>3 pg/mL) in 212 patients (92%) and a concentration above 14 pg/mL was observed in 19.5%. Normalised segmental plaque volumes were positively associated with hsTnT levels (25.0 mm(3) increase in segmental plaque volume per SD increase in ln-transformed hsTnT, 95% CI: 6.0-44.0, p = 0.010). Higher hsTnT levels were measured in patients with a virtual histology derived thin-cap fibroatheroma (VH-TCFA, adj. odds ratio for presence of VH-TCFA = 1.52 per SD increase in ln-transformed hsTnT, 95% CI: 1.10-2.11, p = 0.011). Patients with a VH-TCFA had a 2-fold increased prevalence of hsTnT concentration ≥14 pg/mL (adj. OR 2.35, 95% CI: 1.12-4.91, p = 0.024). In addition, a 3-fold increased prevalence of hsTnT concentration ≥14 pg/mL was observed in patients with a VH-TCFA with a lesional plaque volume higher than the median (adj. OR 3.36, 95% CI: 1.44-7.84, p = 0.005). CONCLUSIONS: Segmental plaque volume and presence of VH-TCFA lesions are associated with higher circulating hsTnT concentrations in stable CAD patients. Subclinical plaque rupture or erosion and distal embolisation may be hypothesized as a potential pathophysiological mechanism with respect to Troponin elevation and its relation with adverse outcome in this patient population.

9 Article Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease. 2014

Oemrawsingh, Rohit M / Cheng, Jin M / García-García, Héctor M / van Geuns, Robert-Jan / de Boer, Sanneke P M / Simsek, Cihan / Kardys, Isabella / Lenzen, Mattie J / van Domburg, Ron T / Regar, Evelyn / Serruys, Patrick W / Akkerhuis, K Martijn / Boersma, Eric / Anonymous1250815. ·Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. · Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands. · Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands; Cardialysis BV, Rotterdam, the Netherlands. · Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands. Electronic address: h.boersma@erasmusmc.nl. ·J Am Coll Cardiol · Pubmed #25500237.

ABSTRACT: BACKGROUND: Near-infrared spectroscopy (NIRS) is capable of identifying lipid core-containing plaques, which can subsequently be quantified as a lipid core burden index (LCBI). Currently, no data are available on the long-term prognostic value of NIRS in patients with coronary artery disease (CAD). OBJECTIVES: This study sought to determine the long-term prognostic value of intracoronary NIRS as assessed in a nonculprit vessel in patients with CAD. METHODS: In this prospective, observational study, NIRS imaging was performed in a nonculprit coronary artery in 203 patients referred for angiography due to stable angina pectoris (SAP) or acute coronary syndrome (ACS). The primary endpoint was the composite of all-cause mortality, nonfatal ACS, stroke, and unplanned coronary revascularization. RESULTS: The 1-year cumulative incidence of the primary endpoint was 10.4%. Cumulative 1-year rates in patients with an LCBI equal to and above the median (43.0) versus those with LCBI values below the median were 16.7% versus 4.0% (adjusted hazard ratio: 4.04; 95% confidence interval: 1.33 to 12.29; p = 0.01). The relation between LCBI and the primary endpoint was similar in SAP and ACS patients (p value for heterogeneity = 0.14). Similar differences between high and low LCBI were observed in pre-specified secondary endpoints. CONCLUSION: CAD patients with an LCBI equal to or above the median of 43.0, as assessed by NIRS in a nonculprit coronary artery, had a 4-fold risk of adverse cardiovascular events during 1-year follow-up. This observation warrants confirmation by larger studies with extended follow-up. (The European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis - Intravascular Ultrasound Study [AtheroRemoIVUS]; NCT01789411).

10 Article Five-year follow-up of the ABSORB bioresorbable everolimus-eluting vascular scaffold system: multimodality imaging assessment. 2013

García-García, Héctor M / Schultz, Carl / Duckers, Eric / Regar, Evelyn / Ligthart, Jurgen / Serruys, Patrick W / van Geuns, Robert J. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #23014900.

ABSTRACT: -- No abstract --

11 Article Relationship between cardiovascular risk factors and biomarkers with necrotic core and atheroma size: a serial intravascular ultrasound radiofrequency data analysis. 2012

García-García, Héctor M / Klauss, Volker / Gonzalo, Nieves / Garg, Scot / Onuma, Yoshinobu / Hamm, Christian W / Wijns, William / Shannon, Jennifer / Serruys, Patrick W. ·Thoraxcenter, Erasmus MC, Ba583, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. h.garciagarcia@erasmusmc.nl ·Int J Cardiovasc Imaging · Pubmed #21594650.

ABSTRACT: We explored the impact of patient demographics, anthropometric measurements, cardiovascular risk factors, and soluble biomarkers on necrotic core and atheroma size in patients with coronary disease. The IBIS-2 trial enrolled 330 patients. In the multivariate analysis, at baseline, creatinine had a positive, whereas baseline mean lumen diameter and myeloperoxidase had a negative, independent association with percentage of necrotic core (PNC); while age, glomerular filtration rate <60, HbA1c, previous PCI or CABG and baseline % diameter stenosis were positively, and acute coronary syndromes (ACS) were negatively associated with baseline percentage atheroma volume (PAV). The variables associated with a decrease in PNC from baseline were darapladib, ACS and a large content of NC at baseline, while variables associated with an increase in PNC were previous stroke and % diameter stenosis at baseline. Those variables associated with a decrease in PAV from baseline were waist circumference, statin use, CD40L and baseline PAV, while the only variable associated with an increase in PAV was baseline diastolic blood pressure. Treatment with darapladib was associated with a decrease in necrotic core, but was not associated with a decrease in percentage atheroma volume. On the contrary, statin use was only associated with a decrease in percentage atheroma volume.

12 Article Evaluation of in-stent restenosis in the APPROACH trial (Assessment on the Prevention of Progression by Rosiglitazone On Atherosclerosis in diabetes patients with Cardiovascular History). 2012

García-García, Héctor M / Garg, Scot / Brugaletta, Salvatore / Morocutti, Giorgio / Ratner, Robert E / Kolatkar, Nikheel S / Kravitz, Barbara G / Miller, Diane M / Huang, Chun / Nesto, Richard W / Serruys, Patrick W / Anonymous6210687. ·Erasmus Medical Center, Z120 Thoraxcentre, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. h.garciagarcia@erasmusmc.nl ·Int J Cardiovasc Imaging · Pubmed #21359834.

ABSTRACT: To determine (1) the medium-term effect of rosiglitazone and glipizide on intra-stent neointima hyperplasia, (2) restenosis pattern as assessed by intra-vascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in patients with T2DM and coronary artery disease. A total of 462 patients with T2DM were randomized to rosiglitazone or glipizide for up to 18 months in the APPROACH trial, and had evaluable baseline and follow-up IVUS examinations. There was no significant difference in the size of plaque behind stent between the rosiglitazone and glipizide groups at 18 months among those treated with a bare metal stent (-5.6 mm(3) vs. 1.9 mm(3); P = 0.61) or with a drug-eluting stent (12.1 mm(3) vs. 5.5 mm(3); P = 0.09). Similarly, there was no significant difference in percentage intimal hyperplasia volume between the rosiglitazone and glipizide groups at 18 months among those treated with a bare metal stent (24.1% vs. 19.8%; P = 0.38) or with a drug-eluting stent (9.8% vs. 8.3%; P = 0.57). QCA data (intra-stent late loss, intra-stent diameter stenosis or binary restenosis) were not different between the rosiglitazone and glipizide groups. This study suggests that both rosiglitazone and glipizide have a similar effect on neointimal growth at medium term follow-up, a finding that warrants investigation in dedicated randomized trials.

13 Article Second-generation optical coherence tomography in clinical practice. High-speed data acquisition is highly reproducible in patients undergoing percutaneous coronary intervention. 2010

Gonzalo, Nieves / Tearney, Guillermo J / Serruys, Patrick W / van Soest, Gijs / Okamura, Takayuki / García-García, Héctor M / Jan van Geuns, Robert / van der Ent, Martin / Ligthart, Jurgen / Bouma, Brett E / Regar, Evelyn. ·Thoraxcenter, Erasmus MC, Rotterdam, Países Bajos. ·Rev Esp Cardiol · Pubmed #20738934.

ABSTRACT: INTRODUCTION AND OBJECTIVES: The development of second-generation optical coherence tomography (i.e. Fourier domain optical coherence tomography, FD-OCT) has made it possible to perform high speed pullbacks during image acquisition without the need for transient occlusion of the coronary artery. The objective of this study was to assess the reproducibility of FD-OCT systems for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention. METHODS: The study included 45 patients scheduled for percutaneous coronary intervention who were enrolled between May and December 2008. Image acquisition was performed by FD-OCT using a non-occlusive technique and employing pullback speeds ranging from 5 to 20 mm/s. Interstudy, interobserver and intraobserver reproducibility of plaque characterization and stent analysis were assessed. RESULTS: Fourier domain imaging was successfully performed in all patients (n=45). The average flush rate was 3+/-0.4 mL/s and the contrast volume per pullback was 16.1+/-3.5 mL. The mean pullback duration and length were 3.2+/-1.2 s and 53.3+/-12.4 mm, respectively. The interstudy reproducibility for visualizing edge dissection, tissue prolapse, intrastent dissection and malapposition was excellent (k=1). The kappa values for interstudy, interobserver and intraobserver agreement on plaque characterization were 0.92, 0.82 and 0.95, respectively. CONCLUSIONS: A second-generation OCT system (i.e. FD-OCT) involving high-speed data acquisition demonstrated good interstudy, interobserver and intraobserver reproducibility for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention.

14 Article Effect of rosiglitazone on progression of coronary atherosclerosis in patients with type 2 diabetes mellitus and coronary artery disease: the assessment on the prevention of progression by rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history trial. 2010

Gerstein, Hertzel C / Ratner, Robert E / Cannon, Christopher P / Serruys, Patrick W / García-García, Héctor M / van Es, Gerrit-Anne / Kolatkar, Nikheel S / Kravitz, Barbara G / Miller, Diane M / Huang, Chun / Fitzgerald, Peter J / Nesto, Richard W / Anonymous680652. ·McMaster University and Hamilton Health Sciences, Department of Medicine, Hamilton, Ontario L8N 3Z5, Canada. gerstein@mcmaster.ca ·Circulation · Pubmed #20194881.

ABSTRACT: BACKGROUND: Rosiglitazone has several properties that may affect progression of atherosclerosis. The Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in Diabetes Patients With Cardiovascular History (APPROACH) study was undertaken to determine the effect of the thiazolidinedione rosiglitazone on coronary atherosclerosis as assessed by intravascular ultrasound compared with the sulfonylurea glipizide. METHODS AND RESULTS: This was a randomized, double-blind, controlled 18-month study in 672 patients aged 30 to 80 years with established type 2 diabetes mellitus treated by lifestyle, 1 oral agent, or submaximal doses of 2 oral agents who had at least 1 atherosclerotic plaque with 10% to 50% luminal narrowing in a coronary artery that had not undergone intervention during a clinically indicated coronary angiography or percutaneous coronary intervention. The primary outcome was change in percent atheroma volume in the longest and least angulated epicardial coronary artery that had not undergone intervention. Secondary outcomes included change in normalized total atheroma volume and change in total atheroma volume in the most diseased baseline 10-mm segment. Rosiglitazone did not significantly reduce the primary outcome of percent atheroma volume compared with glipizide (-0.64%; 95% confidence interval, -1.46 to 0.17; P=0.12). The secondary outcome of normalized total atheroma volume was significantly reduced by rosiglitazone compared with glipizide (-5.1 mm(3); 95% confidence interval, -10.0 to -0.3; P=0.04); however, no significant difference between groups was observed for the change in total atheroma volume within the most diseased baseline 10-mm segment (-1.7 mm(3); 95% confidence interval, -3.9 to 0.5; P=0.13). CONCLUSIONS: Rosiglitazone did not significantly decrease the primary end point of progression of coronary atherosclerosis more than glipizide in patients with type 2 diabetes mellitus and coronary atherosclerosis. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique Identifier: NCT00116831.

15 Article Synergistic effect of cardiovascular risk factors on necrotic core in coronary arteries: a report from the global intravascular radiofrequency data analysis registry. 2009

García-García, Héctor M / Serruys, Patrick W / Mintz, Gary S / Saito, Satoshi / Klaus, Volker / Margolis, Pauliina / Carlier, Stephane / Goedhart, Dick / Schwartz, Robert. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. ·JACC Cardiovasc Imaging · Pubmed #19442952.

ABSTRACT: OBJECTIVES: This study explored whether an individual or a cluster of risk factors affects the extent of necrotic core (NC) assessed by intravascular ultrasound (IVUS) radiofrequency data (RFD) analysis. BACKGROUND: Several systemic diseases contribute to the development of coronary artery disease. METHODS: The Global Intravascular Radiofrequency Data Analysis Registry was a prospective, multicenter, nonrandomized database that enrolled 990 patients with coronary artery disease in whom 1 major coronary artery was imaged by IVUS-RFD. For the multivariable analysis, the population was divided into 4 classes: young women, young men (both 62 years). Mean NC area was categorized as 1: top quartile (>or=0.62 mm(2)) or as 0: lower 3 quartiles. RESULTS: Young patients had less NC compared with older patients (0.40 +/- 0.36 mm(2) of NC vs. 0.50 +/- 0.46 mm(2) in old patients, p = 0.0007). Nondiabetic patients had less NC than diabetic patients (0.43 +/- 0.41 mm(2) of NC vs. 0.51 +/- 0.44 mm(2) in diabetic patients, p = 0.02). The NC area was lower in normotensive patients (0.40 +/- 0.36 mm(2)) than in hypertensive patients (0.48 +/- 0.44 mm(2)) (p = 0.02). In the bivariate analysis, age, hypertension, diabetes, and prior coronary artery bypass graft were statistically significant, however in logistic regression analysis, only age (odds ratio [OR]: 1.023, 95% confidence interval [CI]: 1.009 to 1.037, p = 0.001) and diabetes (OR: 1.636, 95% CI: 1.174 to 2.279, p = 0.004) remained statistically significant. In a per-class logistic regression analyses including only diabetes as covariate, the OR in young women was 2.1 (95% CI: 0.77 to 6.0, p = 0.14), in young men the OR was 1.6 (95% CI: 0.90 to 2.7, p = 0.11), in old women the OR was 2.3 (95% CI: 1.09 to 4.9, p = 0.03), and in old men the OR was 1.6 (95% CI: 0.96 to 2.7, p = 0.07). Further, when only patients with diabetes and hypertension were included, young men (OR: 2.0, p = 0.041), old women (OR: 3.04, p = 0.046), and old men (OR: 2.2, p = 0.025) were significant. CONCLUSIONS: Individually and collectively, age and diabetes mellitus are associated with an increase in NC by IVUS-RFD analysis.

16 Article Coronary plaque composition as assessed by greyscale intravascular ultrasound and radiofrequency spectral data analysis. 2008

Gonzalo, Nieves / García-García, Héctor M / Ligthart, Jurgen / Rodriguez-Granillo, Gastón / Meliga, Emanuele / Onuma, Yoshinobu / Schuurbiers, Johan C H / Bruining, Nico / Serruys, Patrick W. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·Int J Cardiovasc Imaging · Pubmed #18548332.

ABSTRACT: OBJECTIVES: (i) To explore the relation between greyscale intravascular ultrasound (IVUS) plaque qualitative classification and IVUS radiofrequency data (RFD) analysis tissue types; (ii) to evaluate if plaque composition as assessed by RFD analysis can be predicted by visual assessment of greyscale IVUS images. METHODS: In 120 IVUS-RFD cross-sections, a sector of the plaque with homogenous tissue composition (e.g., fibrous, fibrofatty, necrotic core, and dense calcium) was selected. Two experienced observers analyzed twice the corresponding greyscale IVUS images to: (1) classify the selected sectors according to greyscale IVUS plaque type classification and (2) predict the tissue type expected in the sector by RFD analysis. RESULTS: In the greyscale IVUS plaque type classification, the observers agreed in 90/120 sectors (kappa = 0.64). Calcified, soft and mixed plaques by greyscale IVUS classification were mainly composed of dense calcium, fibrofatty, and necrotic core, respectively, in the RFD analysis. The plaques classified in greyscale IVUS as fibrous were actually fibrous tissue by IVUS RFD in only 30% of the cases. Overall, high interobserver variability in the prediction of RFD results by visual assessment of greyscale IVUS images (kappa = 0.23 for observer 1 and 0.55 for observer 2) was found. Sensitivities for detection of calcified tissue and NC by greyscale IVUS visual assessment were 88% and 58%, respectively. CONCLUSIONS: High interobserver variability in the prediction of tissue type by visual assessment of greyscale IVUS images was observed. This underlines the need of quantitative methods for the analysis of the ultrasound characteristics of coronary plaque components.