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Coronary Artery Disease: HELP
Articles by Hector M. Garcia-Garcia
Based on 174 articles published since 2010
(Why 174 articles?)
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Between 2010 and 2020, Hector M. Garcia-Garcia wrote the following 174 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline Defining Staged Procedures for Percutaneous Coronary Intervention Trials: A Guidance Document. 2018

Spitzer, Ernest / McFadden, Eugène / Vranckx, Pascal / de Vries, Ton / Ren, Ben / Collet, Carlos / Onuma, Yoshinobu / Garcia-Garcia, Hector M / Lopes, Renato D / Stone, Gregg W / Cutlip, Donald E / Serruys, Patrick W. ·Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands; Department of Cardiology, Cork University Hospital, Cork, Ireland. · Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium. · Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands. · Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. · Department of Cardiology, MedStar Washington Hospital Center, Washington, DC. · Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina. · Clinical Trials Center, Cardiovascular Research Foundation and Division of Cardiology, Columbia University Medical Center, New York, New York. · Baim Institute for Clinical Research, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. · International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com. ·JACC Cardiovasc Interv · Pubmed #29747912.

ABSTRACT: Patients in coronary intervention trials may require more than 1 procedure to complete the intended revascularization strategy. However, these staged interventions are not consistently defined. Standardized definitions are needed to allow meaningful comparisons of this outcome among trials. This document provides guidance on relevant parameters involving staged procedures, including minimum data collection and consistent classification of coronary procedures initially identified as staged; the aim is to achieve consistency among clinical trialists, sponsors, health authorities, and regulators. Definitions were developed jointly among representatives of academic institutions and clinical research organizations based on clinical trial experience and published literature. Reasons for staged procedures were identified and include baseline kidney function, contrast load and radiation exposure, lesion complexity, and patient or operator fatigue. Moreover, nonclinical reasons include procedure scheduling and reimbursement. Management of staged procedures should be a standalone section in clinical trial protocols and clinical events committee charters. These documents should clearly define a time window for staged procedures that allows latitude for local policies, while respecting accepted clinical guidelines, and consistency with study objectives. Investigators should document in the case report form the intent to stage a procedure, the lesions to be treated, and the reasons for staging, preferably before randomization. Ideally, all reinterventions, or at least all procedures performed after the recommended time window, those in which data suggest an anticipated procedure due to a worsening condition and those where a revascularization is attempted in the target vessel, should be reviewed by an independent clinical events committee.

2 Guideline Clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound regression/progression studies. 2011

Mintz, Gary S / Garcia-Garcia, Hector M / Nicholls, Stephen J / Weissman, Neil J / Bruining, Nico / Crowe, Tim / Tardif, Jean-Claude / Serruys, Patrick W. ·Cardiovascular Research Foundation, New York, NY, USA. ·EuroIntervention · Pubmed #21518687.

ABSTRACT: Atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality despite the widespread use of established medical therapies. This has prompted the search to identify new therapeutic approaches to achieve more effective prevention of cardiovascular events. Considerable interest has focused on the role of surrogate markers of therapeutic efficacy in the early evaluation of novel anti-atherosclerotic therapies. Monitoring changes in the extent of coronary atherosclerosis with intravascular ultrasound (IVUS) has been increasingly employed in clinical trials to assess progression and regression of atherosclerosis. This is based on the pivotal role that atherosclerotic plaque plays in the natural history of cardiovascular disease and the acceptance of validated arterial imaging approaches including coronary angiography and carotid intimal-medial thickness by regulatory authorities. The ability to generate high-resolution imaging of the entire thickness of the coronary artery wall permits evaluation of the entire burden of atherosclerotic plaque. In order to understand the differences, similarities, limitations and pitfalls of the IVUS technique among different academic core laboratories, a number of meetings of representatives from these groups were convened in 2007 and 2008. This document is the result of those IVUS methodology meetings that assembled experts from core laboratories to discuss standards for image acquisition, definitions, criteria, analyses, and primary and secondary endpoints.

3 Editorial Women are from SATURN and men are from an ASTEROID: deciphering the REVERSAL of coronary atheroma. 2014

Garcia-Garcia, Hector M / Campos, Carlos M / Serruys, Patrick W. ·Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. Electronic address: hect2701@gmail.com. · Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands; Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. · Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. ·JACC Cardiovasc Imaging · Pubmed #25323164.

ABSTRACT: -- No abstract --

4 Review The Orsiro ultrathin, bioresorbable-polymer sirolimus-eluting stent: A review of current evidence. 2020

Forrestal, Brian J / Case, Brian C / Yerasi, Charan / Garcia-Garcia, Hector M / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America. Electronic address: ron.waksman@medstar.net. ·Cardiovasc Revasc Med · Pubmed #31952919.

ABSTRACT: Advances in stent design and the development of bioresorbable polymers have allowed the development of novel stent technologies such as the Orsiro bioresorbable-polymer sirolimus eluting stent (BP-SES). Over several noninferiority trials, the BP-SES has demonstrated itself to be a safe and effective therapy for obstructive coronary artery disease. This article reviews the current evidence of the efficacy of the BP-SES and examines its performance in high-risk populations, such as patients presenting with ST-segment myocardial infarction, chronic total occlusions, diabetes, and small vessel disease.

5 Review Second-generation drug-eluting resorbable magnesium scaffold: Review of the clinical evidence. 2019

Ozaki, Yuichi / Garcia-Garcia, Hector M / Shlofmitz, Evan / Hideo-Kajita, Alexandre / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: hector.m.garciagarcia@medstar.net. ·Cardiovasc Revasc Med · Pubmed #31662277.

ABSTRACT: Since October 8, 2013, the second-generation drug-eluting resorbable magnesium scaffold (RMS) has been used to treat coronary lesions. At present, the second-generation drug-eluting RMS is clinically available in Europe, some South American countries, and some Asian and African countries. Furthermore, patients are currently being enrolled in ongoing post-marketing trials. This device has the potential to be an alternative to drug-eluting stents in the future, but there is not yet sufficient evidence. This review provides the latest available evidence, comparison with other bioresorbable scaffolds, future perspectives, and discussion of clinical case reports with second-generation drug-eluting RMS. SUMMARY: Favorable outcomes have been reported after second-generation drug-eluting RMS implantation. More long-term clinical outcomes for this novel device are still required in the future.

6 Review Genetic and Nongenetic Implications of Racial Variation in Response to Antiplatelet Therapy. 2019

Iantorno, Micaela / Weintraub, William S / Garcia-Garcia, Hector M / Attaran, Saina / Gajanana, Deepakraj / Buchanan, Kyle D / Rogers, Toby / Torguson, Rebecca / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net. ·Am J Cardiol · Pubmed #30967284.

ABSTRACT: Race has been identified as an independent risk factor for poor prognosis and an independent predictor of survival in coronary artery disease. Race-related dissimilarities have been identified in cardiovascular patients in terms of age of presentation, co-morbidities, socioeconomic status, and treatment approach as well as genetically driven race-related disparities in responsiveness to medications. Antiplatelet therapy represents a fundamental component of therapy in cardiovascular patients, especially in patients presenting with acute coronary syndromes. It has been argued that the different level of platelet reactivity and varying response to antiplatelet therapy among races may account in part for worse outcomes in certain populations. The purpose of this review is to describe genotypic and phenotypic race-related differences in platelet reactivity and responsiveness to cardiovascular treatment, focusing on antiplatelet therapy to highlight the need establish a more effective and targeted antithrombotic strategy.

7 Review Intracoronary imaging to guide percutaneous coronary intervention: Clinical implications. 2019

Scalone, Giancarla / Niccoli, Giampaolo / Gomez Monterrosas, Omar / Grossi, Pierfrancesco / Aimi, Alessandro / Mariani, Luca / Di Vito, Luca / Kuku, Kayode / Crea, Filippo / Garcia-Garcia, Hector M. ·Cardiology Department, Catholic University of Sacred Heart, Rome, Italy; Department of Cardiology, Mazzoni Hospital, Ascoli Piceno, Italy. Electronic address: gcarlascl@gmail.com. · Cardiology Department, Catholic University of Sacred Heart, Rome, Italy. · Institut Clinic Cardiovascular, Hospital Clinic, IDIBAPS, University of Barcelona, Spain. · Department of Cardiology, Mazzoni Hospital, Ascoli Piceno, Italy. · Section of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, United States of America. ·Int J Cardiol · Pubmed #30213597.

ABSTRACT: BACKGROUND: Over the last decade, the intra-coronary imaging (ICI) has emerged to guide percutaneous coronary intervention (PCI), thus overcoming the limitations of "luminology" offered by angiography. METHODS: In this review, we aim at purely focusing on the clinical implications of the employment of ICI in the routine practice, thus providing suggestions for future applications. In particular, we will describe the principal contributions and implications of ICI in the following different clinical settings: 1) assessment of clinical and imaging outcomes of PCI; 2) guiding PCI before and after stent implantation; 3) identification of mechanisms of stent failure. RESULTS: Several studies showed the capability of ICI in assessing the clinical and imaging outcomes of PCI. In particular, they have compared the ICI-guided PCI with the angiography-guided procedures, emphasizing the advantages of using imaging. Indeed, ICI can characterize the coronary plaque, provide a precise estimation of the coronary stenosis, select the appropriate method of intervention, and optimize stent deployment and lesion coverage. Finally, ICI has been shown to be useful to point out the mechanisms of stent failure. CONCLUSIONS: ICI can facilitate decision-making in patients with unclear angiographic findings, guide-selected interventions and optimize the final PCI results in complex lesions or. in high-risk patients. Finally, by the identification of specific mechanisms of stent failure, the ICI can allow to adopt a tailored therapy for the singles cases.

8 Review Associations of 26 Circulating Inflammatory and Renal Biomarkers with Near-Infrared Spectroscopy and Long-term Cardiovascular Outcome in Patients Undergoing Coronary Angiography (ATHEROREMO-NIRS Substudy). 2018

Anroedh, Sharda S / Akkerhuis, K Martijn / Oemrawsingh, Rohit M / Garcia-Garcia, Hector M / Brankovic, Milos / Regar, Evelyn / van Geuns, Robert-Jan / Serruys, Patrick W / Daemen, Joost / van Mieghem, Nicolas M / Boersma, Eric / Kardys, Isabella. ·Department of Cardiology, Erasmus MC, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. · Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands. · Department of Cardiology, Erasmus MC, Room Rg-4, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. · Department of Cardiology, Erasmus MC, Room Rg-6, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. · Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. · Department of Cardiology, Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. · Cardiovascular Science Division, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK. · Department of Cardiology, Erasmus MC, Room Na-319, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. · Department of Cardiology, Erasmus MC, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. i.kardys@erasmusmc.nl. · Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, The Netherlands. i.kardys@erasmusmc.nl. ·Curr Atheroscler Rep · Pubmed #30218437.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this study was to investigate the association of 26 inflammatory biomarkers (acute phase proteins, cytokines, chemokines) and renal markers with coronary lipid core burden index (LCBI) assessed by near-infrared spectroscopy (NIRS) imaging, as well as the association of these biomarkers with long-term cardiovascular outcome. RECENT FINDINGS: NIRS-derived LCBI has recently been shown to be an independent predictor of major adverse cardiac events (MACE). However, studies on the association between circulating biomarkers and NIRS-derived characteristics have not yet been performed. Between 2008 and 2011, 581 patients underwent diagnostic coronary angiography or percutaneous coronary intervention for stable angina pectoris or acute coronary syndrome (ACS). NIRS of a non-culprit vessel was performed in a subset of 203 patients. In multivariable analyses, TNF-α tended to be associated with higher LCBI (beta 0.088 ln (pg/ml) increase per unit LCBI; 95% CI 0.000-0.177, p = 0.05) after adjustment for clinical characteristics. However, this association did not persist after Bonferroni correction (statistical threshold 0.0019). Major adverse cardiac events (MACE) were registered in 581 patients during a median follow-up time of 4.7 years (IQR: [4.2-5.6] years). After adjustment for clinical characteristics and Bonferroni correction, IL-8 (HR 1.60; 95% CI [1.18-2.17] per ln (pg/ml), p = 0.002) was borderline associated with MACE and significantly associated with all-cause mortality or ACS (HR 1.75; 95% CI [1.24-2.48] per ln (pg/ml), p = 0.0015). In conclusion, we found that IL-8 was independently associated with clinical outcome, but altogether, the multiplex panel we investigated here did not render a useful blood biomarker of high LCBI.

9 Review Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis. 2018

Kuku, Kayode O / Ekanem, Emmanuel / Azizi, Viana / Melaku, Gebremedhin / Bui, Anh / Meirovich, Yael F / Dheendsa, Aaphtaab / Beyene, Solomon / Hideo-Kajita, Alexandre / Lipinski, Michael J / Waksman, Ron / Garcia-Garcia, Hector M. ·Division of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA. · MedStar Georgetown University Hospital, Washington, DC, USA. · Division of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA. hector.m.garciagarcia@medstar.net. ·Int J Cardiovasc Imaging · Pubmed #29151138.

ABSTRACT: The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n = 1753) and OCT-guidance versus IVUS-guidance (n = 1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p = 0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p = 0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p = 0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p = 0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p = 0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p = 0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p = 0.47), MI (OR 0.56 [0.12, 2.70] p = 0.47), ST (OR 0.43 [0.06, 2.95] p = 0.39), and TLR(OR 0.99 [0.45, 2.18] p = 0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.

10 Review Intravascular imaging in cardiovascular ageing. 2018

Bourantas, Christos V / Crake, Tom / Zhang, Yao-Jun / Ozkor, Mick / Ahmed, Javed / Garcia-Garcia, Hector M / Serruys, Patrick W. ·Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK. Electronic address: christos.bourantas@bartshealth.nhs.uk. · Barts Heart Centre, Barts Health NHS Trust, London, UK. · Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. · Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; International Centre for Circulatory Health, NHLI, Imperial College London, London, UK. ·Exp Gerontol · Pubmed #28522312.

ABSTRACT: Ageing is related to complex molecular, inflammatory and biochemical changes that affect coronary pathology and often lead to coronary artery disease and cardiovascular events. Intravascular imaging is considered as the ideal technique to study coronary plaque morphology and assess its burden. Over the recent years several studies have been performed that investigated the association between pathophysiological mechanisms that promote vascular ageing and plaque morphology. In addition, several reports have compared plaque pathology in different age groups and a few studies included serial intravascular imaging to assess changes in the atheroma burden and compositional characteristics of the plaque. This review article summarizes the evidence derived from intravascular imaging studies about the implications of vascular ageing on coronary artery morphology and discusses the potential of coronary imaging in assessing atherosclerotic evolution.

11 Review Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease: Anatomy, Physiology, or Morphology? 2016

Ahmadi, Amir / Stone, Gregg W / Leipsic, Jonathon / Shaw, Leslee J / Villines, Todd C / Kern, Morton J / Hecht, Harvey / Erlinge, David / Ben-Yehuda, Ori / Maehara, Akiko / Arbustini, Eloisa / Serruys, Patrick / Garcia-Garcia, Hector M / Narula, Jagat. ·From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.) · Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.) · University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.) · Emory University School of Medicine, Atlanta, GA (L.J.S.) · Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.) · University of California Irvine (M.J.K.) · Lund University, Sweden (D.E.) · University of California San Diego (O.B.-Y.) · Policlinico San Matteo Pavia Fondazione, Pravia, Italy (E.A.) · Imperial College, London, United Kingdom (P.S.) · and Leesburg Regional Medical Centre, FL (H.M.G.-G.). ·Circ Res · Pubmed #27390334.

ABSTRACT: Risk stratification in patients with stable ischemic heart disease is essential to guide treatment decisions. In this regard, whether coronary anatomy, physiology, or plaque morphology is the best determinant of prognosis (and driver an effective therapeutic risk reduction) remains one of the greatest ongoing debates in cardiology. In the present report, we review the evidence for each of these characteristics and explore potential algorithms that may enable a practical diagnostic and therapeutic strategy for the management of patients with stable ischemic heart disease.

12 Review Defining the non-vulnerable and vulnerable patients with computed tomography coronary angiography: evaluation of atherosclerotic plaque burden and composition. 2016

Rodriguez-Granillo, Gaston A / Carrascosa, Patricia / Bruining, Nico / Waksman, Ron / Garcia-Garcia, Hector M. ·Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina hect2701@gmail.com grodriguezgranillo@gmail.com. · Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina. · Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. · MedStar Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC 20010, USA. · MedStar Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC 20010, USA hect2701@gmail.com grodriguezgranillo@gmail.com. ·Eur Heart J Cardiovasc Imaging · Pubmed #26903599.

ABSTRACT: The shift from coronary plaque stability to plaque instability remains poorly understood despite enormous efforts and expenditures have been assigned to the study of the subject. On the other hand, there have been serious advances in imaging helping us to characterizenon-vulnerable patients The latter has much more value in the clinical decision-making process since it provides high certainty that the patient's probability of a future acute event is low and treatment decisions should be made accordingly. Although coronary plaque rupture is still recognized as the main source of acute thrombotic events, numerous studies have shown that the prediction of events on an individual basis is far more complex and demands a more open approach aimed at characterizing patient risk rather than assessing the risk of thrombosis of a single plaque. Computed tomography coronary angiography (CTCA) has the ability to evaluate non-invasively the extent, burden, severity, and characteristics of coronary artery disease (CAD) and has a close relationship to intravascular ultrasound. On the basis of an excellent negative predictive value with an annualized event rate of ∼0.20% assessed over more than 6000 patients, thus providing a 5-year warranty period, CTCA has been identified as the finest non-invasive tool to exclude CAD. This means that CTCA is able to reliably characterize the non-vulnerable patient. Conversely, in the past few years, several studies have attempted to establish CTCA-derived predictors of acute coronary syndromes, both from a lesion level and a patient level basis with very low positive predictive value, thus questioning the vulnerable patient/plaque concept.

13 Review Vulnerable plaque detection: an unrealistic quest or a feasible objective with a clinical value? 2016

Bourantas, Christos V / Garcia-Garcia, Hector M / Torii, Ryo / Zhang, Yao-Jun / Westwood, Mark / Crake, Tom / Serruys, Patrick W. ·Department of Cardiovascular Sciences, University College London, London, UK Department of Cardiology, Barts Heart Centre, London, UK. · Department of Interventional Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands. · Department of Mechanical Engineering, University College London, London, UK. · Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. · Department of Cardiology, Barts Heart Centre, London, UK. · Department of Interventional Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK. ·Heart · Pubmed #26783236.

ABSTRACT: Evidence from the first prospective studies of coronary atherosclerosis demonstrated that intravascular imaging has limited accuracy in detecting lesions that are likely to progress and cause future events, and divided the scientific community into experts who advocate abandoning this quest and others who suggest intensifying our efforts improve and optimise the available imaging techniques. Although the current evidence may not justify the use of invasive or non-invasive imaging in the clinical setting for the detection of vulnerable, high-risk lesions, it is apparent that imaging has provided unique insights about plaque pathophysiology and evolution. Recent evidence indicates that both invasive and non-invasive imaging also provides useful prognostic information in patients with established coronary artery disease and in asymptomatic individuals and is likely to enable more accurate risk stratification. Future studies are anticipated to provide further insights about the value of novel hybrid imaging techniques, which are expected to enable complete assessment of plaque pathophysiology, in detecting vulnerable lesions and identifying high-risk patients that would benefit from new aggressive treatments targeting coronary atherosclerosis.

14 Review Functional Evaluation of Coronary Disease by CT Angiography. 2015

Gonçalves, Pedro de Araújo / Rodríguez-Granillo, Gastón A / Spitzer, Ernest / Suwannasom, Pannipa / Loewe, Christian / Nieman, Koen / Garcia-Garcia, Hector M. ·Hospital de Santa Cruz, Hospital da Luz, and CEDOC-Nova Medical School, Lisbon, Portugal. · Department of Cardiovascular Imaging, Diagnostico Maipu, and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina. · Cardialysis B.V., Rotterdam, the Netherlands. · Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. · Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. · Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands. · Cardialysis B.V., Rotterdam, the Netherlands; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: hect2701@gmail.com. ·JACC Cardiovasc Imaging · Pubmed #26563862.

ABSTRACT: In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.

15 Review Imaging plaques to predict and better manage patients with acute coronary events. 2014

Garcia-Garcia, Hector M / Jang, Ik-Kyung / Serruys, Patrick W / Kovacic, Jason C / Narula, Jagat / Fayad, Zahi A. ·From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.) · Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.) · and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY. ·Circ Res · Pubmed #24902974.

ABSTRACT: Culprit lesions of patients, who have had an acute coronary syndrome commonly, are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques, such as intravascular ultrasound (and derived techniques), optical coherence tomography, and near-infrared spectroscopy. Often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed noninvasively by computed tomographic angiography and MRI and also using invasive imaging. The detection of these remote plaques is not only feasible but also in natural history studies have been associated with clinical coronary events. Different systemic pharmacological treatments have been studied (mostly statins) with modest success and, therefore, newer approaches are being tested. Local treatment for such lesions is in its infancy and larger, prospective, and randomized trials are needed. This review will describe the pathological and imaging findings in culprit lesions of patients with acute coronary syndrome and the assessment of remote plaques. In addition, the pharmacological and local treatment options will be reviewed.

16 Review Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials. 2014

Zhang, Yaojun / Tian, Nailiang / Dong, Shengjie / Ye, Fei / Li, Minghui / Bourantas, Christos V / Iqbal, Javaid / Onuma, Yoshinobu / Muramatsu, Takashi / Diletti, Roberto / Garcia-Garcia, Hector M / Xu, Bo / Serruys, Patrick W / Chen, Shaoliang. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, 3015CE, The Netherlands. · Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. · Soochow University, Suzhou, Jiangsu 215021, China. · Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing 100037, China. · Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. Email: chmengx126@gmail.com. ·Chin Med J (Engl) · Pubmed #24890171.

ABSTRACT: BACKGROUND: Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial. METHODS: We searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR). RESULTS: We identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES. CONCLUSIONS: Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.

17 Review Computed tomography angiography for the interventional cardiologist. 2014

de Araújo Gonçalves, Pedro / Campos, Carlos A M / Serruys, Patrick W / Garcia-Garcia, Hector M. ·Hospital de Santa Cruz, CHLO, Lisbon, Portugal Hospital da Luz, Lisbon, Portugal CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal. · Thoraxcenter, Erasmus Medical Center, Room z120, 's Gravendijkwal 230, Rotterdam, CE 3015, The Netherlands Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. · Thoraxcenter, Erasmus Medical Center, Room z120, 's Gravendijkwal 230, Rotterdam, CE 3015, The Netherlands. · Thoraxcenter, Erasmus Medical Center, Room z120, 's Gravendijkwal 230, Rotterdam, CE 3015, The Netherlands hect2701@gmail.com. ·Eur Heart J Cardiovasc Imaging · Pubmed #24711515.

ABSTRACT: In recent years, coronary CT angiography (CCTA) has become a widely adopted technique, not only due to its high diagnostic accuracy, but also to the fact that CCTA provides a comprehensive evaluation of the total (obstructive and non-obstructive) coronary atherosclerotic burden. More recently, this technique has become mature, with a large body of evidence addressing its prognostic validation. In addition, CT angiography has moved from the field of 'imagers' and clinicians and entered the interventional cardiology arena, aiding in the planning of both coronary and structural heart interventions, being transcatheter aortic valve implantation one of its most successful examples. It is therefore of utmost importance that interventional cardiologists become familiar with image interpretation and up-to-date regarding several CTA features, taking advantage of this information in planning the procedure, ultimately leading to improvement in patient outcomes. On the other hand, the increasing use of CCTA as a gatekeeper for invasive coronary angiography is expected to lead to an increase in the ratio of interventional to diagnostic procedures and significant changes in the daily cath-lab routine. In a foreseeable future, cath-labs will probably offer an invasive procedure only to patients expected to undergo an intervention, perhaps becoming in this change true interventional-labs.

18 Review Bioresorbable drug-eluting magnesium-alloy scaffold for treatment of coronary artery disease. 2013

Campos, Carlos M / Muramatsu, Takashi / Iqbal, Javaid / Zhang, Ya-Jun / Onuma, Yoshinobu / Garcia-Garcia, Hector M / Haude, Michael / Lemos, Pedro A / Warnack, Boris / Serruys, Patrick W. ·Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam 3015 GD, The Netherlands. p.w.j.c.serruys@erasmusmc.nl. ·Int J Mol Sci · Pubmed #24351829.

ABSTRACT: The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothelialization and healing process resulting in late persistent or acquired malapposition of the permanent metallic implant. Delayed endotheliaization and malapposition may lead to late and very late stent thrombosis. Bioresorbable scaffolds (BRS) have been introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Magnesium is an essential mineral needed for a variety of physiological functions in the human body and its bioresorbable alloy has the strength-to-weight ratio comparable with that of strong aluminum alloys and alloy steels. The aim of this review is to present the new developments in Magnesium BRS technology, to describe its clinical application and to discuss the future prospects of this innovative therapy.

19 Review Early detection and invasive passivation of future culprit lesions: a future potential or an unrealistic pursuit of chimeras? 2013

Bourantas, Christos V / Garcia-Garcia, Hector M / Diletti, Roberto / Muramatsu, Takashi / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. ·Am Heart J · Pubmed #23708157.

ABSTRACT: New advances in image and signal processing have allowed the development of numerous invasive and noninvasive imaging modalities that have revealed details of plaque pathology and allowed us to study in vivo the atherosclerotic evolution. Recent natural history of atherosclerosis studies permitted us to evaluate changes in the compositional and morphological characteristics of the plaque and identify predictors of future events. The idea of being able to identify future culprit lesions and passivate these plaques has gradually matured, and small scale studies have provided proofs about the feasibility of this concept. This review article summarizes the recent advances in the study of atherosclerosis, cites the current evidence, highlights our limitations in understanding the evolution of the plaque and in predicting plaque destabilization, and discusses the potentiality of an early invasive sealing of future culprit lesions.

20 Review Hybrid intravascular imaging: current applications and prospective potential in the study of coronary atherosclerosis. 2013

Bourantas, Christos V / Garcia-Garcia, Hector M / Naka, Katerina K / Sakellarios, Antonios / Athanasiou, Lambros / Fotiadis, Dimitrios I / Michalis, Lampros K / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. ·J Am Coll Cardiol · Pubmed #23500282.

ABSTRACT: The miniaturization of medical devices and the progress in image processing have allowed the development of a multitude of intravascular imaging modalities that permit more meticulous examination of coronary pathology. However, these techniques have significant inherent limitations that do not allow a complete and thorough assessment of coronary anatomy. To overcome these drawbacks, fusion of different invasive and noninvasive imaging modalities has been proposed. This integration has provided models that give a more detailed understanding of coronary artery pathology and have proved useful in the study of the atherosclerotic process. In this review, the authors describe the currently available hybrid imaging approaches, discuss the technological innovations and efficient algorithms that have been developed to integrate information provided by different invasive techniques, and stress the advantages of the obtained models and their potential in the study of coronary atherosclerosis.

21 Review Bioresorbable scaffolds: current knowledge, potentialities and limitations experienced during their first clinical applications. 2013

Bourantas, Christos V / Onuma, Yoshinobu / Farooq, Vasim / Zhang, Yaojun / Garcia-Garcia, Hector M / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. ·Int J Cardiol · Pubmed #22748288.

ABSTRACT: The traditional metallic stents have significant limitations as they predispose to late thrombosis, may preclude surgical revascularization and distort vessel physiology. Bioresorbable scaffolds (BRSs) are a relatively new technology introduced to overcome these drawbacks. The potential of these devices as well as the reported results from their clinical applications attracted interest and drove research and industry towards the development of new BRSs and the improvement of the existing devices. Thus, over the last years considerable progress has been made and today numerous BRSs are available. The aim of this review article is to highlight the potentialities of these devices, describe the evidence from the recent clinical trials and discuss the advantages, limitations and concerns that were aroused during the first implementation of BRSs in clinical arena.

22 Review Bioresorbable scaffolds: current evidence and ongoing clinical trials. 2012

Bourantas, Christos V / Zhang, Yaojun / Farooq, Vasim / Garcia-Garcia, Hector M / Onuma, Yoshinobu / Serruys, Patrick W. ·Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. ·Curr Cardiol Rep · Pubmed #22810889.

ABSTRACT: Bioresorbable scaffolds (BRS) represent a novel approach in coronary stent technology. In contrast to the metallic stents, they provide transient scaffolding, thereby safeguarding early vessel patency and acute gain. Subsequently a process of "decomposition" occurs, that results in the complete absorption of the scaffold. This reduces the risk of late complications, allowing the vessel to maintain its integrity and physiological function. This unique ability has attracted interest and nowadays several BRS are available. The aim of this review article is to describe the advances in the field, present the evidence from the preclinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.

23 Review Tools & techniques: risk stratification and diagnostic tools in left main stem intervention. 2011

Farooq, Vasim / Heo, Jung Ho / Räber, Lorenz / Brugaletta, Salvatore / Radu, Maria / Gogas, Bill D / Diletti, Roberto / Onuma, Yoshinobu / Garcia-Garcia, Hector M / Serruys, Patrick W. ·Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #21986332.

ABSTRACT: -- No abstract --

24 Review Assessment of drug-eluting stents and bioresorbable stents by grayscale IVUS and IVUS-based imaging modalities. 2011

Brugaletta, Salvatore / Costa, Jose Ribamar / Garcia-Garcia, Hector M. ·Thoraxcenter, Z120, Erasmus MC, Dr Molewaterplein 40, 3015 Rotterdam, The Netherlands. ·Int J Cardiovasc Imaging · Pubmed #21279692.

ABSTRACT: Grayscale IVUS and IVUS-based imaging modalities during the last years have become useful in the assessment not only of drug eluting stent, but also of new bioresorbable vascular scaffolds. Although IVUS resolution is not sufficient for determining stent coverage (optical coherence tomography is the gold standard), serial IVUS can measure intimal hyperplasia, assess acute and late incomplete stent apposition, detect the presence and persistence of edge dissections, study edge effects and look for causes of restenosis and thrombosis. In addition other IVUS-based imaging modalities, such as IVUS-VH, iMAP or palpography, can be used to study the serial compositional and mechanical changes of the plaque behind stent struts and also to follow the bioresorption of the new bioresorbable scaffolds, analyzing the backscattering signal coming from the polymeric struts. This review details and evaluates grayscale IVUS and IVUS-based techniques findings in clinical trials, highlighting the usefulness of these imaging modalities in the study of drug eluting stents and bioresorbable vascular scaffold.

25 Review Imaging of coronary atherosclerosis: intravascular ultrasound. 2010

Garcia-Garcia, Hector M / Costa, Marco A / Serruys, Patrick W. ·Interventional Cardiology, Thoraxcenter, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. ·Eur Heart J · Pubmed #20823109.

ABSTRACT: Atherosclerosis is the main cause of coronary heart disease, which is today the leading cause of death worldwide and will continue to be the first in the world in 2030. In the formation of atherosclerotic coronary lesions, a critical primary step is the accumulation and oxidation of low-density lipoprotein (LDL) particles. Oxidized-LDL favours leucocyte recruitment and their activation, as well as cell death. This leads to generation of complex atherosclerotic plaques. These plaques have a high content of necrotic core, a thin inflamed fibrous cap (intense accumulation of macrophages) and scarce presence of smooth muscle cells (i.e. thin-capped fibroatheroma). At early stages of the formation of the atheroma, the remodelling of the vessel wall usually prevents plaque from encroaching on the lumen, thereby masking the presence of atheroma on angiography. In contrast, greyscale intravascular ultrasound can fully assess the extension of the disease axially and longitudinally. This intravascular imaging technique has played a vital role in advancing our understanding of the pathophysiology of coronary artery disease, and in the development of novel cardiovascular drugs and device therapies. This intravascular imaging technology and its clinical and research applications are discussed in more detail below.

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