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Coronary Artery Disease: HELP
Articles by Christian W. Hamm
Based on 79 articles published since 2010
(Why 79 articles?)
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Between 2010 and 2020, C. Hamm wrote the following 79 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline [ESC/EACTS guidelines on myocardial revascularization : Amendments 2014]. 2014

Nef, H / Renker, M / Hamm, C W / Anonymous1190812 / Anonymous1200812. ·Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen, Klinikstr. 33, 35392, Gießen, Deutschland, holger.nef@me.com. ·Herz · Pubmed #25406330.

ABSTRACT: One of the most important treatment principles in interventional cardiology relies on myocardial revascularization by percutaneous coronary intervention (PCI) or surgical placement of coronary artery bypass grafts (CABG). However, in order to apply these principles effectively, it is important to identify patients who require revascularization. Consequently, the appropriate method has to be selected to effectively restore blood flow. Patients will only benefit from the interventional or surgical procedures when those revascularization measures that can cause more harm than good are avoided. In the new European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization some new aspects will be addressed.

2 Guideline 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 2014

Kolh, Philippe / Windecker, Stephan / Alfonso, Fernando / Collet, Jean-Philippe / Cremer, Jochen / Falk, Volkmar / Filippatos, Gerasimos / Hamm, Christian / Head, Stuart J / Jüni, Peter / Kappetein, A Pieter / Kastrati, Adnan / Knuuti, Juhani / Landmesser, Ulf / Laufer, Günther / Neumann, Franz-Josef / Richter, Dimitrios J / Schauerte, Patrick / Sousa Uva, Miguel / Stefanini, Giulio G / Taggart, David Paul / Torracca, Lucia / Valgimigli, Marco / Wijns, William / Witkowski, Adam / Anonymous7870804 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Çetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous7880804 / Sousa Uva, Miguel / Achenbach, Stephan / Pepper, John / Anyanwu, Anelechi / Badimon, Lina / Bauersachs, Johann / Baumbach, Andreas / Beygui, Farzin / Bonaros, Nikolaos / De Carlo, Marco / Deaton, Christi / Dobrev, Dobromir / Dunning, Joel / Eeckhout, Eric / Gielen, Stephan / Hasdai, David / Kirchhof, Paulus / Luckraz, Heyman / Mahrholdt, Heiko / Montalescot, Gilles / Paparella, Domenico / Rastan, Ardawan J / Sanmartin, Marcelo / Sergeant, Paul / Silber, Sigmund / Tamargo, Juan / ten Berg, Jurrien / Thiele, Holger / van Geuns, Robert-Jan / Wagner, Hans-Otto / Wassmann, Sven / Wendler, Olaf / Zamorano, Jose Luis / Anonymous7890804 / Anonymous7900804. ·(Belgium) philippe.kolh@chu.ulg.ac.be stephan.windecker@insel.ch. · (Switzerland) philippe.kolh@chu.ulg.ac.be stephan.windecker@insel.ch. · (Spain). · (France). · (Germany). · (Switzerland). · (Greece). · (Netherlands). · (Finland). · (Austria). · (Portugal). · (UK). · (Italy). · (Belgium). · (Poland). · (Turkey). · (Israel). · (Germany/UK). · (Czech Republic). · (Norway). · (USA). · (UK/Germany). ·Eur J Cardiothorac Surg · Pubmed #25173601.

ABSTRACT: -- No abstract --

3 Guideline 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 2014

Anonymous7760804 / Windecker, Stephan / Kolh, Philippe / Alfonso, Fernando / Collet, Jean-Philippe / Cremer, Jochen / Falk, Volkmar / Filippatos, Gerasimos / Hamm, Christian / Head, Stuart J / Jüni, Peter / Kappetein, A Pieter / Kastrati, Adnan / Knuuti, Juhani / Landmesser, Ulf / Laufer, Günther / Neumann, Franz-Josef / Richter, Dimitrios J / Schauerte, Patrick / Sousa Uva, Miguel / Stefanini, Giulio G / Taggart, David Paul / Torracca, Lucia / Valgimigli, Marco / Wijns, William / Witkowski, Adam. · ·Eur Heart J · Pubmed #25173339.

ABSTRACT: -- No abstract --

4 Editorial Calcium and C-reactive protein hot enough to predict the future? 2011

Hamm, Christian W / Nef, Holger M / Rolf, Andreas / Möllmann, Helge. · ·J Am Coll Cardiol · Pubmed #21435515.

ABSTRACT: -- No abstract --

5 Review A new novolimus-eluting bioresorbable coronary scaffold: Present status and future clinical perspectives. 2017

Nef, Holger M / Wiebe, Jens / Foin, Nicolas / Blachutzik, Florian / Dörr, Oliver / Toyloy, Sara / Hamm, Christian W. ·University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen, Germany. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · National Heart Centre Singapore, Singapore. · Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Department of Cardiology, Erlangen, Germany. Electronic address: florian.blachutzik@uk-erlangen.de. · Elixir Medical, 870 Hermosa Drive, Sunnyvale, CA 94965, USA. ·Int J Cardiol · Pubmed #27863289.

ABSTRACT: The DESolve® scaffold (Elixir Medical Corporation, Sunnyvale, California, USA) is manufactured from a poly-l-lactide based polymer and elutes an anti-proliferative, anti-inflammatory drug, Novolimus from a poly-l-lactide based topcoat mixture. The strut thickness is 150μm and the scaffold has platinum-iridium radiopaque markers at both ends. Radial support is available during the early time period to prevent recoil. The scaffold biodegrades within 1year (>90% reduction in molecular weight) and then completely bioresorbs within 2years. The DESolve® scaffold permits a wide range of expansion with a consequently reduced risk for strut fracture. Lumen and scaffold enlargement is observed within 3-6months in both preclinical and clinical studies potentially allowing for the scaffolded region to respond to vasoactive stimuli. The device has a unique property of self-correction observed in bench top studies, which in clinical practice has the potential to eliminate minor malapposition following deployment.

6 Review [Computed tomography in patients with chronic stable angina : Fractional flow reserve measurement]. 2017

Renker, M / Schoepf, U J / Becher, T / Krampulz, N / Kim, W / Rolf, A / Möllmann, H / Hamm, C W / Henzler, T / Borggrefe, M / Akin, I / Baumann, S. ·Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland. matthias.renker@web.de. · Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. · I.Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg und DZHK (Deutsches Zentrum für Herz-Kreislaufforschung), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. · Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland. · Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Deutschland. · Institut für Klinische Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Heidelberg, Deutschland. ·Herz · Pubmed #27255115.

ABSTRACT: Coronary computed tomography angiography (cCTA) has been established for the non-invasive diagnosis of coronary artery disease (CAD). Previous studies demonstrated the high diagnostic accuracy of cCTA, particularly for ruling out CAD. As a known limitation of cCTA a large number of visually significant coronary stenoses are found to be hemodynamically not relevant by invasive fractional flow reserve (FFR). CT-based FFR (CT-FFR) builds on recent advances in computational fluid dynamics and image simulation techniques. Along with CT myocardial perfusion imaging, CT-FFR is a promising approach towards a more accurate estimation of the hemodynamic relevance of coronary artery stenoses. CT-FFR is derived from regular CT datasets without additional image acquisitions, contrast material, or medication. Two CT-FFR techniques can be differentiated. The initial method requires external use of supercomputers and has gained approval for clinical use in the USA. Furthermore, a prototype-software has been introduced which is less computationally demanding via integration of reduced-order models for on-site calculation of CT-FFR. The present article reviews these methods in the context of available study results and meta-analyses. Furthermore, limitations and future concepts of CT-FFR are discussed.

7 Review Bioresorbable scaffolds in daily clinical routine: a practical review of all-comers results. 2015

Wiebe, Jens / Hamm, Christian W / Nef, Holger M. ·aUniversity of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen bDeutsches Herzzentrum München, Munich cKerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. ·Curr Opin Cardiol · Pubmed #26447503.

ABSTRACT: PURPOSE OF REVIEW: Bioresorbable scaffolds (BRS) are a major advancement in interventional cardiology, but experience with BRS use in daily routine is currently limited. Here, we review technical features of commercially available BRS and place them in context with current clinical scientific evidence. RECENT FINDINGS: Everolimus and novolimus-eluting poly-L-lactic acid (PLLA)-based BRS are commercially available in Europe. The everolimus-eluting BRS is the most widely investigated BRS and several all-comers investigations with this device are ongoing. Of the patients in these studies, 37-100% underwent catheterization due to acute coronary syndrome and up to 25% were diabetic. Up to 64.7% of all lesions treated were considered to be complex. Follow-up varied between 30 days and 1 year. The target lesion revascularization rate was up to 10% and scaffold thrombosis was 0-3%. SUMMARY: Accumulating data on BRS application are now available. Several studies have demonstrated that BRS implantation is technically feasible in a variety of different patient subsets and clinical presentations, and follow-up results support BRS use. Patients with acute coronary syndrome represent the most investigated subpopulation, and results suggest that BRS use for this indication is reasonable.

8 Review Current status of bioresorbable scaffolds in the treatment of coronary artery disease. 2014

Wiebe, Jens / Nef, Holger M / Hamm, Christian W. ·Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany. · Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany. Electronic address: christian.hamm@innere.med.uni-giessen.de. ·J Am Coll Cardiol · Pubmed #25500240.

ABSTRACT: State-of-the-art drug-eluting metal stents are the gold standard for interventional treatment of coronary artery disease. Although they overcome some disadvantages and limitations of plain balloon angioplasty and bare-metal stents, some limitations apply, most notably a chronic local inflammatory reaction due to permanent implantation of a foreign body, restriction of vascular vasomotion due to a metal cage, and the risk of late and very late stent thrombosis. The development of biodegradable scaffolds is a new approach that attempts to circumvent these drawbacks. These devices provide short-term scaffolding of the vessel and then dissolve, which should theoretically circumvent the side effects of metal drug-eluting stents. Various types of these bioresorbable scaffolds are currently under clinical evaluation. This review discusses different concepts of bioresorbable scaffolds with respect to material, design, and drug elution and presents the most recent evidence.

9 Review Open issues in transcatheter aortic valve implantation. Part 1: patient selection and treatment strategy for transcatheter aortic valve implantation. 2014

Bax, Jeroen J / Delgado, Victoria / Bapat, Vinayak / Baumgartner, Helmut / Collet, Jean P / Erbel, Raimund / Hamm, Christian / Kappetein, Arie P / Leipsic, Jonathon / Leon, Martin B / MacCarthy, Philip / Piazza, Nicolo / Pibarot, Philippe / Roberts, William C / Rodés-Cabau, Josep / Serruys, Patrick W / Thomas, Martyn / Vahanian, Alec / Webb, John / Zamorano, Jose Luis / Windecker, Stephan. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands j.j.bax@lumc.nl. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands. · Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK. · Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. · Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. · Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Essen, Germany. · Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany. · Erasmus Medical Center, Rotterdam, The Netherlands. · St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital, New York, USA. · Cardiovascular Department, King's College Hospital, London, UK. · Interventional Cardiology, McGill University Health Center, Montreal, Canada Cardiovascular Surgery, German Heart Center Munich, Bavaria, Germany. · Quebec Heart and Lung Institute, Québec, Canada. · Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, TX, USA. · Department of Cardiology, Laval University, Quebec, Canada. · Bichat Hospital, University Paris VII, Paris, France. · Cardiac Imaging Department, University Hospital Ramon y Cajal, Madrid, Spain. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. ·Eur Heart J · Pubmed #25062952.

ABSTRACT: An exponential increase in the use of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis has been witnessed over the recent years. The current article reviews different areas of uncertainty related to patient selection. The use and limitations of risk scores are addressed, followed by an extensive discussion on the value of three-dimensional imaging for prosthesis sizing and the assessment of complex valve anatomy such as degenerated bicuspid valves. The uncertainty about valvular stenosis severity in patients with a mismatch between the transvalvular gradient and the aortic valve area, and how integrated use of echocardiography and computed tomographic imaging may help, is also addressed. Finally, patients referred for TAVI may have concomitant mitral regurgitation and/or coronary artery disease and the management of these patients is discussed.

10 Clinical Trial A randomized, parallel group, double-blind study of ticagrelor compared with aspirin for prevention of vascular events in patients undergoing coronary artery bypass graft operation: Rationale and design of the Ticagrelor in CABG (TiCAB) trial: An Investigator-Initiated trial. 2016

de Waha, Antoinette / Sandner, Sigrid / von Scheidt, Moritz / Boening, Andreas / Koch-Buettner, Katharina / Hammel, Dieter / Hambrecht, Rainer / Danner, Bernhard C / Schöndube, Friedrich A / Goerlach, Gerold / Fischlein, Theodor / Schmoeckel, Michael / Oberhoffer, Martin / Schulz, Rainer / Walther, Thomas / Ziegelhöffer, Tibor / Knosalla, Christoph / Schönrath, Felix / Beyersdorf, Friedhelm / Siepe, Matthias / Attmann, Tim / Misfeld, Martin / Mohr, Friedrich-Wilhelm / Sievers, Hans-Hinrich / Joost, Alexander / Putman, Leon M / Laufer, Günther / Hamm, Christian / Zeymer, Uwe / Kastrati, Adnan / Radke, Peter W / Lange, Rüdiger / Cremer, Jochen / Schunkert, Heribert. ·German Heart Center Munich, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), and partner site Munich Heart Alliance, Munich, Germany. Electronic address: dewaha@dhm.mhn.de. · Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. · German Heart Center Munich, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), and partner site Munich Heart Alliance, Munich, Germany. · Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Germany. · Department of Cardiac Surgery, Klinikum Links der Weser, Bremen, Germany. · Department of Cardiology and Angiology, Klinikum Links der Weser, Bremen, Germany. · Department of Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Goettingen, Germany. · Department of Cardiac Surgery, Paracelsus Medical University, Klinikum Nürnberg, Germany. · Department of Cardiac Surgery, Asklepios Klinik St. Georg/Cardioclinic Harburg, Hamburg, Germany. · Institute of Physiology, Justus-Liebig University, Giessen, Germany. · Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. · Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Germany. · Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Germany; DZHK (German Center for Cardiovascular research)-partner side Berlin. · Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. · Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany. · Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. · Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany. · Medical Clinic II, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. · Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany Justus Liebig University of Giessen, Department of Internal Medicine I, Gießen, Germany. · Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen am Rhein, Germany. · Klinik für Innere Medizin, Schön Klinik Neustadt, Neustadt i.H., Germany. · Department of Cardiovascular Surgery, German Heart Center Munich, Germany. ·Am Heart J · Pubmed #27595681.

ABSTRACT: BACKGROUND: For patients with coronary artery disease undergoing coronary bypass surgery, acetylsalicylic acid (ASA) currently represents the gold standard of antiplatelet treatment. However, adverse cardiovascular event rates in the first year after coronary artery bypass grafting (CABG) still exceed 10%. Graft failure, which is predominantly mediated by platelet aggregation, has been identified as a major contributing factor in this context. Therefore, intensified platelet inhibition is likely to be beneficial. Ticagrelor, an oral, reversibly binding and direct-acting P2Y12 receptor antagonist, provides a rapid, competent, and consistent platelet inhibition and has shown beneficial results compared with clopidogrel in the subset of patients undergoing bypass surgery in a large previous trial. HYPOTHESIS: Ticagrelor is superior to ASA for the prevention of major cardiovascular events within 1 year after CABG. STUDY DESIGN: The TiCAB trial (NCT01755520) is a multicenter, phase III, double-blind, double-dummy, randomized trial comparing ticagrelor with ASA for the prevention of major cardiovascular events within 12 months after CABG. Patients undergoing CABG will be randomized in a 1:1 fashion to either ticagrelor 90 mg twice daily or ASA 100 mg once daily. The study medication will be started within 24 hours after surgery and maintained for 12 months. The primary end point is the composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization at 12 months after CABG. The sample size is based on an expected event rate of 13% of the primary end point within the first 12 months after randomization in the control group, a 2-sided α level of .0492 (to preserve the overall significance level of .05 after planned interim analysis), a power of 0.80%, 2-sided testing, and an expected relative risk of 0.775 in the active group compared with the control group and a dropout rate of 2%. According to power calculations based on a superiority design for ticagrelor, it is estimated that 3,850 patients should be enrolled. SUMMARY: There is clinical equipoise on the issue of optimal platelet inhibition after CABG. The TiCAB trial will provide a pivotal comparison of the efficacy and safety of ticagrelor compared with ASA after CABG.

11 Clinical Trial β-Blockers and ivabradine differentially affect cardiopulmonary function and left ventricular filling index. 2016

Fischer-Rasokat, Ulrich / Honold, Jörg / Lochmann, Denise / Wolter, Sebastian / Liebetrau, Christoph / Fichtlscherer, Stephan / Möllmann, Helge / Spyridopoulos, Ioakim / Hamm, Christian W. ·Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany. fischer-rasokat@gmx.de. · Department of Cardiology, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany. · Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany. ·Clin Res Cardiol · Pubmed #26687495.

ABSTRACT: OBJECTIVE: Patients with left ventricular (LV) diastolic dysfunction are characterized by exertional dyspnoea. Heart rate (HR) reduction by β-blockers can improve exercise tolerance by prolonging LV filling, but their negative inotropic and lusitropic properties can be detrimental in this disease. We tested the effects of administering ivabradine, a HR-lowering drug without impact on cardiac kinetics that may favorably affect diastolic function. METHODS: Twenty-four patients with coronary artery disease (CAD) and normal LV ejection fraction on chronic β-blocker therapy were included. NT-proBNP serum levels were determined prior to and after cardiopulmonary exercise. β-Blockers were then replaced by ivabradine and patients were re-tested after 6 weeks. Patients were initially classified as having a low (E/e' ≤ 8; n = 11) or high (E/e' > 8; n = 13) LV filling index. RESULTS: E/e' significantly decreased during ivabradine therapy in patients with high E/e' (10.7 ± 2.9 vs. 8.9 ± 1.7; p < 0.01), whereas no difference occurred in patients with low E/e' (6.4 ± 0.7 vs. 6.5 ± 1.1; p = ns). With ivabradine, patients with high E/e' had an increased oxygen uptake at the anaerobic threshold (from 10.8 ± 1.4 to 11.8 ± 1.9 ml/min/kg; p < 0.05) and a steeper slope of the initial oxygen pulse curve (from 293 ± 109 to 359 ± 117 µl/beat/kg/W; p < 0.05). Moreover, patients with high E/e' had lower NT-proBNP serum levels at rest (169 ± 207 vs. 126 ± 146 pg/ml; p < 0.05) and after exercise (190 ± 256 vs. 136 ± 162 pg/ml; p < 0.05) during ivabradine therapy. CONCLUSIONS: In patients with CAD and elevated E/e', switching therapy from β-blockers to ivabradine may cause a reduction in LV filling pressures and an improved stroke volume response to exercise.

12 Clinical Trial Short- and long-term health related quality-of-life and anginal status of the Arterial Revascularisation Therapies Study part II, ARTS-II; sirolimus-eluting stents for the treatment of patients with multivessel coronary artery disease. 2010

van Domburg, Ron T / Daemen, Joost / Morice, Marie-Claude / de Bruyne, Bernard / Colombo, Antonio / Macaya, Carlos / Richardt, Gert / Fajadet, Jean / Hamm, Christian / van Es, Gerrit-Anne / Wittebols, Kristel / Macours, Nathalie / Stoll, Hans Peter / Serruys, Patrick W. ·Erasmus Medical Center, Rotterdam, The Netherlands. r.vandomburg@erasmusmc.nl ·EuroIntervention · Pubmed #20542782.

ABSTRACT: AIMS: Assessment of health related quality-of-life (HRQL) has become increasingly important as not only the clinician's view of the technical success, but also the patient's perception is being measured. We evaluated the HRQL following sirolimus-eluting coronary stent (SES) (CYPHER(R); Cordis, Johnson & Johnson, Warren, NJ, USA) implantation in patients with multivessel disease, comparing the outcomes with the historical surgical and bare metal stent (BMS) arms of the ARTS-I study. METHODS AND RESULTS: The HRQL outcomes were compared to the outcome of the historical cohorts of the randomised ARTS-I trial using the same inclusion and exclusion criteria. HRQL was evaluated at baseline, at one month and at 6, 12 and 36 months after revascularisation using the SF-36 in patients treated with SES (n=585), BMS (n=483) or coronary artery bypass graft (CABG) (n=492). The HRQL compliance rates varied from 100% at baseline to 92% at 36 months. Both stenting and CABG resulted in significant improvement of HRQL and anginal status. There was a trend towards better HRQL after CABG than BMS beyond six months. Already from the first month up to three years, SES patients had, on average, 10% significantly better HRQL than BMS patients on the HRQL subscales physical functioning, role physical functioning, role emotional functioning and mental health (p<0.01) and a trend towards better HRQL in the other subscales. Up to 12 months, the HRQL was better after SES than CABG and was identical thereafter. At all time points, angina was more prevalent in the BMS group than in both the SES and CABG groups, in which the incidence of angina was similar. At three years, 10% of the SES patients suffered from angina, 13% of the CABG patients and 20% of the BMS patients. CONCLUSIONS: Both stenting and CABG resulted in a significant improvement in HRQL and angina. Along with a substantial reduction of restenosis, HRQL after SES was significantly improved as compared with BMS, and was similar to CABG.

13 Clinical Trial 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. 2010

Serruys, Patrick W / Onuma, Yoshinobu / Garg, Scot / Vranckx, Pascal / De Bruyne, Bernard / Morice, Marie-Claude / Colombo, Antonio / Macaya, Carlos / Richardt, Gert / Fajadet, Jean / Hamm, Christian / Schuijer, Monique / Rademaker, Tessa / Wittebols, Kristel / Stoll, Hans Peter / Anonymous2240651. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. p.w.j.c.serruys@erasmusmc.nl ·J Am Coll Cardiol · Pubmed #20171036.

ABSTRACT: OBJECTIVES: The purpose of this study is to compare the 5-year clinical outcomes, safety, and efficacy of sirolimus-eluting stents (SES) in the ARTS II (Arterial Revascularization Therapies Study II) with the outcomes of coronary artery bypass graft (CABG) and bare-metal stenting (BMS) from the ARTS I. BACKGROUND: The long-term outcomes after SES implantation in patients with multivessel disease remains to be established. METHODS: The ARTS I was a randomized trial of 1,205 patients with multivessel disease comparing CABG and BMS. The ARTS II study was a nonrandomized trial with the Cypher sirolimus-eluting stent (Cordis, a Johnson & Johnson Company, Warren, New Jersey), applying the same inclusion and exclusion criteria, end points, and protocol definitions. The ARTS II trial enrolled 607 patients, with an attempt to enroll at least one-third of patients with 3-vessel disease. RESULTS: At 5-year, the death/stroke/myocardial infarction event-free survival rate was 87.1% in ARTS II SES, versus 86.0% (p = 0.1) and 81.9% (p = 0.007) in ARTS I CABG and BMS cohorts, respectively. The 5-year major adverse cardiac and cerebrovascular event (MACCE) rate in ARTS II (27.5%) was significantly higher than ARTS I CABG (21.1%, p = 0.02), and lower than in ARTS I BMS (41.5%, p < 0.001). The cumulative incidence of definite stent thrombosis was 3.8%. Thirty-two percent (56 of 176) of major adverse cardiac events (MACE) at 5 years were related to possible, probable, or definite stent thrombosis. CONCLUSIONS: At 5 years, SES had a safety record comparable to CABG and superior to BMS, and a MACCE rate that was higher than in patients treated with CABG, and lower than in those treated with BMS. Approximately one-third of the events seen with SES could be prevented through the elimination of early, late, and very late stent thrombosis.

14 Article Five-year follow-up of patients who underwent everolimus-eluting bioresorbable scaffold implantation. 2020

Wiebe, Jens / Hofmann, Felix J / Dörr, Oliver / Bauer, Timm / Boeder, Niklas / Liebetrau, Christoph / Blachutzik, Florian / Möllmann, Helge / Elsässer, Albrecht / Achenbach, Stephan / Hamm, Christian W / Nef, Holger M. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany. · Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. · Department of Internal Medicine I, St. Johannes-Hospital, Dortmund, Germany. · Department of Cardiology, Klinikum Oldenburg, Oldenburg, Germany. · Medizinische Klinik 2, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. ·Catheter Cardiovasc Interv · Pubmed #32187817.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate very long-term results after unrestricted everolimus-eluting bioresorbable scaffolds (BRS) implantation. BACKGROUND: Previous randomized studies mainly included selected patients differing from those seen during daily routine and long-term data from all-comers registries are sparse. METHODS: Consecutive patients undergoing BRS implantation were included in this observational, single center study. Clinical follow-up was conducted up to 5 years. Endpoint of interest was the composite of target lesion failure (TLF), including target-vessel myocardial infarction and target lesion revascularization and cardiac death. Furthermore, ARC-defined scaffold thrombosis (ScT) were assessed. RESULTS: A total of 176 patients with a median age of 64 (55 - 72) years were analyzed, of which 59.6% presented an acute coronary syndrome. A total of 183 mainly complex lesions (55.8%) were treated. At 5 years, the rate for TLF was 21.6%. Definite or probable ScT rate was 4.1%. The rate of ScT within the first year was 2.8% and afterwards 1.2%. Notably, no ScT was seen later than 2 years. CONCLUSIONS: Although this real-world registry displays high rates of clinical events during long-term follow-up, no ScT was seen after 2 years.

15 Article Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study. 2020

Chichareon, Ply / Modolo, Rodrigo / Kogame, Norihiro / Takahashi, Kuniaki / Chang, Chun-Chin / Tomaniak, Mariusz / Botelho, Roberto / Eeckhout, Eric / Hofma, Sjoerd / Trendafilova-Lazarova, Diana / Kőszegi, Zsolt / Iñiguez, Andres / Wykrzykowska, Joanna J / Piek, Jan J / Garg, Scot / Hamm, Christian / Steg, Philippe Gabriel / Jüni, Peter / Vranckx, Pascal / Valgimigli, Marco / Windecker, Stephan / Onuma, Yoshinobu / Serruys, Patrick W. ·Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. · Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division. University of Campinas (UNICAMP). Campinas, Brazil. · Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands. · Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. · Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. · CT / Instituto Do Coracao Do Triangulo Mineiro, Uberlandia, Brazil. · Department of Cardiology, Lausanne University Hospital, Switzerland. · The Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. · "St. Ekaterina" University Hospital, Sofia, Bulgaria. · Jósa András Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary. · Cardiology Department. Hospital Universitario Álvaro Cunqueiro, Vigo, Spain. · East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. · Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany. · Université Paris-Diderot, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM U-1148, FACT (French Alliance for Cardiovascular Trials), Paris, France; National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom. · Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada. · Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt, Belgium. · Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland. · Department of Cardiology, National University of Ireland Galway, Galway, Ireland. · Department of Cardiology, National University of Ireland Galway, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com. ·Atherosclerosis · Pubmed #32006758.

ABSTRACT: BACKGROUND AND AIMS: Diabetes has been well recognized as a strong predictor for adverse outcomes after percutaneous coronary intervention (PCI), however, studies in the era of drug-eluting stent and potent P2Y12 inhibitors have shown conflicting results. We aimed to assess ischemic and bleeding outcomes after contemporary PCI according to diabetic status. METHODS: We studied 15,957 patients undergoing PCI for stable or acute coronary syndrome in the GLOBAL LEADERS study with known baseline diabetic status. The primary endpoint was all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was major bleeding defined as bleeding academic research consortium (BARC) type 3 or 5. RESULTS: A quarter of the study cohort were diabetic (4038/15,957), and these patients had a significantly higher risk of primary endpoint at 2 years compared to non-diabetics (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17-1.63). The difference was driven by a significantly higher risk of all-cause mortality at 2 years in diabetics (adjusted HR 1.47, 95% CI 1.22-1.78). The risk of BARC 3 or 5 bleeding was comparable between the two groups (adjusted HR 1.09, 95% CI 0.86-1.39). The antiplatelet strategy (experimental versus reference strategy) had no significant effect on the rates of primary endpoint and secondary safety endpoint at 2 years in patients with and without diabetes. CONCLUSIONS: Diabetic patients had higher risk of ischemic events after PCI than non-diabetic patients, whilst bleeding risk was comparable. The outcomes of diabetic patients following PCI were not affected by the two different antiplatelet strategies.

16 Article Association between post-percutaneous coronary intervention bivalirudin infusion and net adverse clinical events: a post hoc analysis of the GLOBAL LEADERS study. 2020

Chang, Chun Chin / Chichareon, Ply / Modolo, Rodrigo / Takahashi, Kuniaki / Kogame, Norihiro / Tomaniak, Mariusz / Gao, Chao / Royaards, Kees-Jan / Cequier, Angel / Oldroyd, Keith / Steg, Philippe Gabriel / Hamm, Christian / Jüni, Peter / Valgimigli, Marco / Windecker, Stephan / Onuma, Yoshinobu / Stables, Rod H / Jan van Geuns, Robert / Serruys, Patrick W. ·Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, GD Rotterdam, Netherlands. · Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Beitou 11217, Taipei, Taiwan. · Institute of Clinical Medicine, National Yang Ming University, Beitou 11221, Taipei, Taiwan. · Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. · Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand. · Cardiology Department, Radboudumc, Comeniuslaan 4 6525 HP, Nijmegen, the Netherlands. · Department of Cardiology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, Netherlands. · Department of Cardiology, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. · West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK. · Cardiology Department, AP-HP, Hospital, Bichat, 75018 Paris, France. · Department of Cardiology, Kerckhoff Heart Center, 61231Bad Nauheim, Germany. · Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M4P 1A6, Canada. · Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland. · Cardialysis B.V., 3012 KM Rotterdam, Netherlands. · Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK. · National Heart and Lung Institute, Imperial College London, London, UK. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #31841136.

ABSTRACT: AIMS: The efficacy and safety of continued bivalirudin infusion after percutaneous coronary intervention (PCI) remains uncertain. We sought to investigate the association between post-PCI bivalirudin infusion and the risk of net adverse clinical events (NACE) at 30 days. METHODS AND RESULTS: In the GLOBAL LEADERS study, all patients who received bivalirudin during PCI were categorized according to the use of bivalirudin infusion after the procedure. The primary endpoint of the present analysis was NACE [a composite of all-cause death, any stroke, any myocardial infarction, all revascularization, and bleeding assessed according to the Bleeding Academic Research Consortium (BARC) criteria Type 3 or 5] at 30 days. The key safety endpoint was BARC Type 3 or 5 bleeding and definite stent thrombosis. Of 15 968 patients, 13 870 underwent PCI with the use of bivalirudin. In total, 7148 patients received continued bivalirudin infusion after procedure, while 6722 patients received standard care. After propensity score covariate adjustment, the risk of NACE did not significantly differ between two treatments after PCI [continued bivalirudin infusion vs. no bivalirudin infusion: 3.2% vs. 3.1%, adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI) 0.99-1.84, P = 0.06] nor the BARC Type 3 or 5 bleeding (0.7% vs. 0.7%, aHR 0.89, 95% CI 0.44-1.79; P = 0.743) and definite stent thrombosis (0.5% vs. 0.3%, aHR 1.71, 95% CI 0.77-3.81, P = 0.189). However, continued bivalirudin infusion was associated with an increased risk of NACE and definite stent thrombosis in ST-elevation myocardial infarction (STEMI) patients. CONCLUSION: In an all-comers population undergoing PCI, there was no significant difference in the risk of NACE at 30 days between continued bivalirudin infusion vs. no bivalirudin infusion after procedure but continued bivalirudin infusion was associated with a higher risk of NACE in STEMI patients when compared with no infusion.

17 Article Comparison between treatment of "established" versus complex "off-label" coronary lesions with Absorb 2020

Huseynov, Aydin / Baumann, Stefan / Nef, Holger / Riemer, Thomas / Schneider, Steffen / Pfannenbecker, Thomas / Achenbach, Stephan / Mehilli, Julinda / Münzel, Thomas / Gori, Tommaso / Wöhrle, Jochen / Zahn, Ralf / Kastner, Johannes / Schmermund, Axel / Richardt, Gert / Hamm, Christian W / Akin, Ibrahim. ·First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. · DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany. · Department of Cardiology, University of Giessen, Giessen, Germany. · IHF GmbH, Institut für Herzinfarktforschung, Ludwigshafen, Germany. · Abbott Vascular Deutschland, Wetzlar, Germany. · Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. · Department of Cardiology, Central Clinic Bad Berka, Bad Berka, Germany. · University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany. · Department of Internal Medicine II, Cardiology, University Hospital of Ulm, Ulm, Germany. · Deparment of Cardiology, Heart Centre Ludwigshafen, Ludwigshafen, Germany. · Department of Cardiology, University of Vienna Medical School, Vienna, Austria. · Bethanien Hospital, Frankfurt, Germany. · Heart Centre Segeberger Kliniken GmbH, Bad Segeberg, Germany. · First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. ibrahim.akin@umm.de. · DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany. ibrahim.akin@umm.de. ·Clin Res Cardiol · Pubmed #31256259.

ABSTRACT: OBJECTIVES: The purpose of this study was to compare the clinical outcomes of patients treated with bioresorbable scaffold (BRS) for off-label versus approved indications. BACKGROUND: The BRS promised some advantages in terms of complete biodegradation within 2-4 years, restored vascular physiology, and absence of potential stent-related long-term complications. However, the implication of BRS for off-label indications and further long-term follow-up of this particular patient group is not well described. METHODS: The short- and long-term outcome after implantation of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) was evaluated in the prospective, non-interventional, multicenter real-world German-Austrian ABSORB RegIstRy (GABI-R). RESULTS: A total of 3188 patients were enrolled. Patients were divided into two groups: on-label BRS use (33.0%) and off-label use (66.9%) if at least one off-label use criteria was met. The incidence of scaffold thrombosis in confirmed cases was significantly higher in off-label group (1.3% versus 0.5%, p = 0.04; OR 2.41 (95% CI 1.00-5.82) with also a trend toward higher myocardial infarction rate (2.3% versus 1.4%, p = 0.077; OR 1.70 (95% CI 0.95-3.03) and cardiovascular death (1.2% versus 1.1%, p = 0.76, OR 1.11 (95% CI 0.56-2.21) at 6-month follow-up. CONCLUSIONS: In a real-world setting, the majority patients were treated with BRS for off-label indications. The off-label use of BRS compared to confirmed indications appears to be associated with a higher rate of clinical endpoints considering more complex lesions and higher morbidity in this patients' group. Comparison between treatment of "established" versus complex "off-label" coronary lesions with Absorb

18 Article Impact of established cardiovascular disease on outcomes in the randomized global leaders trial. 2019

Garg, Scot / Chichareon, Ply / Kogame, Norihiro / Takahashi, Kuniaki / Modolo, Rodrigo / Chang, Chun-Chin / Tomaniak, Mariusz / Fath-Ordoubadi, Farzin / Anderson, Richard / Oldroyd, Keith G / Stables, Rod H / Kukreja, Neville / Chowdhary, Saqib / Galasko, Gavin / Hoole, Stephen / Zaman, Azfar / Hamm, Christian W / Steg, Philippe G / Jüni, Peter / Valgimigli, Marco / Windecker, Stephan / Onuma, Yoshinobu / Serruys, Patrick W. ·Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK. · Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, Netherlands. · Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. · Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP). Campinas, Brazil. · Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands. · First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. · Manchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trust, Manchester, UK. · Department of Cardiology, University Hospital of Wales, Cardiff, UK. · West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK. · Liverpool Heart and Chest Hospital, Liverpool, UK. · Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK. · Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK. · Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. · Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK. · Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. · Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany. · FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP-HP; Université Paris-Diderot; and INSERM U-1148, Paris, France. · Royal Brompton Hospital, Imperial College, London, UK. · Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Department of Cardiology, National University of Ireland Galway, Galway, Ireland. · NHLI, Imperial College London, London, UK. ·Catheter Cardiovasc Interv · Pubmed #31854112.

ABSTRACT: OBJECTIVE: To investigate the impact of different anti-platelet strategies on outcomes after percutaneous coronary intervention (PCI) in patients with established cardiovascular disease (CVD). METHODS: GLOBAL LEADERS was a randomized, superiority, all-comers trial comparing one-month dual anti-platelet therapy (DAPT) with ticagrelor and aspirin followed by 23-month ticagrelor monotherapy (experimental treatment) with standard 12-month DAPT followed by 12-month aspirin monotherapy (reference treatment) in patients treated with a biolimus A9-eluting stent. Established CVD was defined as ≥1 prior myocardial infarction, PCI, coronary artery bypass operation, stroke, or established peripheral vascular disease. The primary endpoint was a composite of all-cause death or new Q-wave MI at 2-years. The secondary safety endpoint was BARC 3 or 5 bleeding. Exploratory secondary endpoints were the patient-orientated composite endpoint and net adverse clinical events. RESULTS: Among the 15,761 patients in this cohort were 6,693 patients (42.5%) with established CVD. Compared to those without established CVD, these patients had significantly higher rates of the primary (5.1 vs. 3.3%, HR1.59[1.36-1.86], p < .001) and secondary composite endpoints with no significant differences in bleeding. There was a nonsignificant reduction in the primary endpoint in patients with established CVD receiving the experimental treatment (4.6 vs. 5.6%, HR0.82[0.66-1.02], p = .07). When comparing patients without CVD to those with one or three territories of CVD, the hazard ratio for the primary endpoint increased in unadjusted and adjusted models. CONCLUSIONS: The poorer outcomes in patients with established CVD are not mitigated by prolonged monotherapy with a potent P2Y12 inhibitor suggesting a greater need to focus on modifiable risk factors.

19 Article Efficacy and safety with ticagrelor in patients with prior myocardial infarction in the approved European label: insights from PEGASUS-TIMI 54. 2019

Dellborg, Mikael / Bonaca, Marc P / Storey, Robert F / Steg, P Gabriel / Im, Kyung A / Cohen, Marc / Bhatt, Deepak L / Oude Ophuis, Ton / Budaj, Andrezej / Hamm, Christian / Spinar, Jindrich / Kiss, Robert G / Lopez-Sendon, José / Kamensky, Gabriel / Van de Werf, Frans / Ardissino, Diego / Kontny, Frederic / Montalescot, Gilles / Johanson, Per / Bengtsson, Olof / Himmelmann, Anders / Braunwald, Eugene / Sabatine, Marc S. ·Department of Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, Gothenburg, Sweden. · Harvard Medical School, TIMI Study Group, Boston, MA, USA. · University of Sheffield, Sheffield, UK. · University Paris Diderot, INSERM Unite 1148, Hôptial Bichat, Paris, France. · Newark Beth Israel Medical Center, Rutgers New Jersey Medical School, Newark, NJ, USA. · Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands. · Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland. · Kerckhoff Heart Center, Bad Nauheim, University of Giessen, Giessen, Germany. · University Hospital, Jihlavska, Brno, Czech Republic. · Department of Cardiology, Military Hospital, Budapest, Hungary. · Cardiovascular Division, University Hospital La Paz, Madrid, Spain. · Department of Noninvasive Cardiovascular Diagnostics, Vth Internal Clinic, University Hospital Bratislava, Bratislava, Slovakia. · University of Leuven, Leuven, Belgium. · Division of Cardiology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy. · Department of Cardiology, Stavanger University Hospital, Stavanger, Norway. · Drammen Heart Center, Drammen, Norway. · Sorbonne Université Paris 6, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France. · AstraZeneca, Mölndal, Sweden. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #31218354.

ABSTRACT: AIMS: In PEGASUS-TIMI 54, ticagrelor significantly reduced the risk of the composite of major adverse cardiovascular (CV) events by 15-16% in stable patients with a prior myocardial infarction (MI) 1-3 years earlier. We report the efficacy and safety in the subpopulation recommended for treatment in the European (EU) label, i.e. treatment with 60 mg b.i.d. initiated up to 2 years from the MI, or within 1 year after stopping previous adenosine diphosphate receptor inhibitor treatment. METHODS AND RESULTS: Of the 21 162 patients enrolled in PEGASUS-TIMI 54, 10 779 patients were included in the primary analysis for this study, randomized to ticagrelor 60 mg (n = 5388) or matching placebo (n = 5391). The cumulative proportions of patients with events at 36 months were calculated by the Kaplan-Meier (KM) method. The composite of CV death, MI, or stroke occurred less frequently in the ticagrelor group (7.9% KM rate vs. 9.6%), hazard ratio (HR) 0.80 [95% confidence interval (CI) 0.70-0.91; P = 0.001]. Ticagrelor also reduced the risk of all-cause mortality, HR 0.80 (0.67-0.96; P = 0.018). Thrombolysis in myocardial infarction major bleeding was more frequent in the ticagrelor group 2.5% vs. 1.1%; HR 2.36 (1.65-3.39; P < 0.001). The corresponding HR for fatal or intracranial bleeding was 1.17 (0.68-2.01; P = 0.58). CONCLUSION: In PEGASUS-TIMI 54, treatment with ticagrelor 60 mg as recommended in the EU label, was associated with a relative risk reduction of 20% in CV death, MI, or stroke. Thrombolysis in myocardial infarction major bleeding was increased, but fatal or intracranial bleeding was similar to placebo. There appears to be a favourable benefit-risk ratio for long-term ticagrelor 60 mg in this population. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov NCT01225562.

20 Article Validation of the updated logistic clinical SYNTAX score for all-cause mortality in the GLOBAL LEADERS trial. 2019

Chichareon, Ply / Onuma, Yoshinobu / van Klaveren, David / Modolo, Rodrigo / Kogame, Norihiro / Takahashi, Kuniaki / Chang, Chun Chin / Tomaniak, Mariusz / Asano, Taku / Katagiri, Yuki / van Geuns, Robert-Jan M / Bolognese, Leonardo / Tumscitz, Carlo / Vrolix, Mathias / Petrov, Ivo / Garg, Scot / Naber, Christoph Kurt / Sabaté, Manel / Iqbal, Javaid / Wykrzykowska, Joanna J / Piek, Jan J / Spitzer, Ernest / Jüni, Peter / Hamm, Christian / Steg, Philippe Gabriel / Valgimigli, Marco / Vranckx, Pascal / Windecker, Stephan / Serruys, Patrick W. ·Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands. ·EuroIntervention · Pubmed #31217143.

ABSTRACT: AIMS: The aim of this study was the external validation of the updated logistic clinical SYNTAX score for two-year all-cause mortality after PCI in the GLOBAL LEADERS trial. METHODS AND RESULTS: The GLOBAL LEADERS trial was an investigator-initiated, prospective randomised, multicentre, open-label trial comparing two strategies of antiplatelet therapy in 15,991 patients undergoing PCI. As a predefined analysis, we studied the first 4,006 consecutive patients enrolled between July 2013 and April 2014 for whom the anatomic SYNTAX scores were calculated by an independent core lab. The updated logistic clinical SYNTAX score was available in 3,271 patients. Patients were divided into quintiles according to the score. The C-statistic of the updated logistic clinical SYNTAX score for two-year all-cause mortality was 0.71 (95% confidence interval [CI]: 0.64-0.77). The updated logistic clinical SYNTAX score identified patients at very high risk for two-year all-cause mortality after PCI. Although it systematically overestimated two-year all-cause mortality, predicted and observed two-year all-cause mortality in the majority of the patients (four out of five quintiles) were in agreement. CONCLUSIONS: Overall discrimination for two-year all-cause mortality of the updated logistic clinical SYNTAX score is either borderline acceptable or possibly helpful. Calibration in the majority of patients is appropriate. The score is potentially useful in selecting enriched high-risk populations.

21 Article Everolimus- vs. novolimus-eluting bioresorbable scaffolds in patients with acute coronary syndrome. 2019

Nef, H M / Wiebe, J / Schmidt, G / Möllmann, H / Boeder, N F / Dörr, O / Bauer, T / Blachutzik, F / Liebetrau, C / Elsässer, A / Foin, N / Hamm, C W. ·Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany. holger.nef@innere.med.uni-giessen.de. · Deutsches Herzzentrum Muenchen, Munich, Germany. · Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany. · Department of Cardiology, St. Johannes Hospital, Dortmund, Germany. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Kerckhoff Heart Center, Bad Nauheim, Germany. · Department of Cardiology, University of Oldenburg, Oldenburg, Germany. · Duke-NUS Medical School, National Heart Centre Singapore, Singapore, Singapore. ·Herz · Pubmed #31209520.

ABSTRACT: BACKGROUND: Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable scaffolds (Absorb). METHODS: In this retrospective study, patients with ACS (including unstable angina pectoris, ST-segment elevation myocardial infarction, or non-ST-segment elevation myocardial infarction) treated with either the Absorb or the DESolve BRS were evaluated in a 1:1 matched-pair analysis. Major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization, were evaluated as a major endpoint. The occurrence of scaffold thrombosis was also assessed. RESULTS: A total of 102 patients were eligible for this analysis. The rate of MACE at 12 months was comparable between the Absorb and the DESolve group (8.3% vs. 6.8%, p = 0.738). The occurrence of target lesion revascularization (6.2% vs. 4.7%; p = 0.700) and scaffold thrombosis (4.1% vs. 2.1%; p = 0.580) was comparable as well. All instances of scaffold thrombosis occurred within 30 days of the index procedure. CONCLUSION: In this study, similar 12-month event rates were observed for both BRS types after implantation for the treatment of ACS.

22 Article Hybrid Coronary Percutaneous Treatment with Metallic Stents and Everolimus-Eluting Bioresorbable Vascular Scaffolds: 2-years Results from the GABI-R Registry. 2019

Gori, Tommaso / Achenbach, Stephan / Riemer, Thomas / Mehilli, Julinda / Nef, Holger M / Naber, Christoph / Richardt, Gert / Wöhrle, Jochen / Zahn, Ralf / Neumann, Till / Kastner, Johannes / Schmermund, Axel / Hamm, Christian / Münzel, Thomas. ·Zentrum für Kardiologie, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany. tomgori@hotmail.com. · German Centre for Cardiovascular Research, partner site Rhine Main, 55131 Mainz, Germany. tomgori@hotmail.com. · Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany. achenbach@uni-erlangen.de. · IHF GmbH-Institut für Herzinfarktforschung, 67063 Ludwigshafen, Germany. riemer@ihf.de. · Department of Cardiology, Munich University Clinic, LMU, 80539 Munich, Germany. mehilli@lmu.de. · German Centre for Cardiovascular Research, partner site Munich Heart Alliance, 80539 Munich, Germany. mehilli@lmu.de. · Department of Cardiology, University of Giessen, Medizinische Klinik I, 35392 Giessen, Germany. h.nef@me.com. · Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, 45138 Essen, Germany. naber@contilia.de. · Herzzentrum, Segeberger Kliniken GmbH, 23795 Bad Segeberg, Germany. richrdt@segeberg.de. · Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany. woehrle@ulm.de. · Abteilung für Kardiologie, Herzzentrum Ludwigshafen, 67063 Ludwigshafen, Germany. zahn@klinikum.de. · Department of Cardiology, University of Essen, 45138 Essen, Germany. neumann@uniwien.at. · Department of Cardiology, University of Vienna Medical School, 1090 Wien, Austria. kastner@viennw.at. · Bethanien Hospital, 60389 Frankfurt, Germany. schmermund@ccb.de. · Department of Cardiology, University of Giessen, Medizinische Klinik I, 35392 Giessen, Germany. hamm@neuheim.de. · Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231 Bad Nauheim, Germany. hamm@neuheim.de. · Zentrum für Kardiologie, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany. tmuenzel@uni-mainz.de. · German Centre for Cardiovascular Research, partner site Rhine Main, 55131 Mainz, Germany. tmuenzel@uni-mainz.de. ·J Clin Med · Pubmed #31151213.

ABSTRACT: The limitations of the first-generation everolimus-eluting coronary bioresorbable vascular scaffolds (BVS) have been demonstrated in several randomized controlled trials. Little data are available regarding the outcomes of patients receiving hybrid stenting with both BVS and drug-eluting stents (DES). Of 3144 patients prospectively enrolled in the GABI-Registry, 435 (age 62 ± 10, 19% females, 970 lesions) received at least one BVS and one metal stent (hybrid group). These patients were compared with the remaining 2709 (3308 lesions) who received BVS-only. Patients who had received hybrid stenting had more frequently a history of cardiovascular disease and revascularization (

23 Article Rationale and design of a prospective substudy of clinical endpoint adjudication processes within an investigator-reported randomised controlled trial in patients with coronary artery disease: the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY). 2019

Leonardi, Sergio / Franzone, Anna / Piccolo, Raffaele / McFadden, Eugene / Vranckx, Pascal / Serruys, Patrick / Benit, Edouard / Liebetrau, Christoph / Janssens, Luc / Ferrario, Maurizio / Zurakowski, Aleksander / van Geuns, Robert-Jan / Dominici, Marcello / Huber, Kurt / Slagboom, Ton / Buszman, Paweł / Bolognese, Leonardo / Tumscitz, Carlo / Bryniarski, Krzysztof / Aminian, Adel / Vrolix, Mathias / Petrov, Ivo / Garg, Scot / Naber, Christoph / Prokopczuk, Janusz / Hamm, Christian / Steg, Gabriel / Heg, Dik / Juni, Peter / Windecker, Stephan / Valgimigli, Marco. ·University of Pavia, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. · Department of Cardiology, Cork University Hospital Group, Cork, Ireland. · Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Hasselt, Belgium. · Department of Cardiology, Imperial College of London, London, UK. · Department of Cardiology, Jessa Hospital, Hasselt, Belgium. · Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany. · Department of Cardiology, Imelda Hospital, Bonheiden, Belgium. · Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland. · Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. · Department of Cardiology, S. Maria University-Hospital, Terni, Italy. · 3rd Med Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria. · Department of Cardiology, OLVG, Amsterdam, The Netherlands. · Center for Cardiovascular Research and Development, American Heart of Poland, Poland, Poland. · Department of Cardiology, Azienda Toscana USL Sudest, Arezzo, Italy. · Department of Cardiology, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Italy. · Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland. · Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium. · Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. · Department of Cardiology, Adzhibadem Siti Klinik Surdechno-sudovi Center, Sofia, Bulgaria. · Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, UK. · Department of Cardiology and Angiology, Contilia Heart and Vascular Centre, Essen, Germany. · Department of Cardiology, PAKS Kozle, Kozle, Poland. · Kerckhoff Heart Center, Bad Nauheim, Germany. · Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France. · CTU, Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern, Switzerland. · Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada. · Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland. ·BMJ Open · Pubmed #30852547.

ABSTRACT: INTRODUCTION: The GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias. METHODS AND ANALYSIS: We designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90 mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months followed by aspirin monotherapy for the primary efficacy endpoint of death, non-fatal myocardial infarction, non-fatal stroke or urgent target vessel revascularisation and superior for the primary safety endpoint of type 3 or 5 bleeding according to the Bleeding Academic Research Consortium criteria.This study will comprehensively assess the comparative safety and efficacy of the two tested antithrombotic strategies on CEC-adjudicated ischaemic and bleeding endpoints and will provide insights into the role of a standardised CEC adjudication process on the interpretation of study findings by quantifying the level of concordance between IR-reported and CEC-adjudicated events. ETHICS AND DISSEMINATION: GLASSY has been approved by local ethics committee of all study sites and/or by the central ethics committee for the country depending on country-specific regulations. In all cases, they deemed that it was not necessary to obtain further informed consent from individual subjects. TRIAL REGISTRATION NUMBER: NCT01813435.

24 Article Predictive ability of ACEF and ACEF II score in patients undergoing percutaneous coronary intervention in the GLOBAL LEADERS study. 2019

Chichareon, Ply / Modolo, Rodrigo / van Klaveren, David / Takahashi, Kuniaki / Kogame, Norihiro / Chang, Chun-Chin / Katagiri, Yuki / Tomaniak, Mariusz / Asano, Taku / Spitzer, Ernest / Buszman, Pawel / Prokopczuk, Janusz / Fath-Ordoubadi, Farzin / Buysschaert, Ian / Anderson, Richard / Oldroyd, Keith G / Merkely, Bela / Garg, Scot / Wykrzykowska, Joanna J / Piek, Jan J / Jüni, Peter / Hamm, Christian / Steg, Philippe Gabriel / Valgimigli, Marco / Vranckx, Pascal / Windecker, Stephan / Onuma, Yoshinobu / Serruys, Patrick W. ·Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. · Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil. · Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands. · Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands. · Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. · Department of Cardiology, Erasmus Medical Centre, Thorax Centre, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. · Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, the Netherlands. · Medical University of Silesia, Katowice, Poland; American Heart of Poland, Ustron, Poland. · IV Department of Cardiology, American Heart of Poland, Kędzierzyn Koźle, Poland. · Manchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trusts, Oxford Rd, Manchester M13 9WL, United Kingdom. · Department of Cardiology, ASZ Hospital Aalst, Merestraat 80, 9300 Aalst, Belgium. · Cardiff and Vale University Health Board Heath Park, Cardiff, Wales, United Kingdom. · West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom. · Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. · Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada. · Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany. · FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, AP-HP, Université Paris-Diderot, INSERM U-1148, Paris, France; Royal Brompton Hospital, Imperial College, London, United Kingdom. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium. · NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com. ·Int J Cardiol · Pubmed #30846254.

ABSTRACT: BACKGROUND: ACEF score has been shown to have predictive ability in the patients undergoing percutaneous coronary intervention (PCI). The ACEF II score has recently been developed to predict short-term mortality after cardiac surgery. We compared the predictive ability of the ACEF and ACEF II scores to predict mortality after PCI in the all-comers population. METHODS: The ACEF and ACEF II scores were calculated in 15,968 patients enrolled in the GLOBAL LEADERS study. Discrimination and calibration were assessed for outcomes after PCI. Recalibration of the regression model by updating the intercept and slope were performed to adjust the original ACEF model to the PCI setting. In a stratified approach, patients were divided into quintiles according to the score. Outcomes were compared between quintiles. RESULTS: The ACEF and ACEF II score were available in 14,941 and 14,355 patients respectively. Discrimination for 30-day all-cause mortality was acceptable for both scores (C-statistic ACEF 0.75 and ACEF II 0.77). For 2-year all-cause mortality, the discrimination of ACEF score was acceptable (C-statistic 0.72) while the discrimination of ACEF II score was moderate (C-statistic 0.69). Both scores identified patients at high risk of mortality but overestimated all-cause mortality at 30 days in all quintiles. After recalibration, agreement between predicted and observed 30-day all-cause mortality in both scores are close to the identity line. CONCLUSIONS: The ACEF II model did not improve the predictive ability of the ACEF score. Recalibrated ACEF model can be used to estimated all-cause mortality rate at 30 days after PCI.

25 Article [MINOCA-myocardial infarction with non-obstructive coronary arteries]. 2018

Hamm, C / Hamm, C W. ·Campus Kerckhoff, Universität Gießen, Bad Nauheim, Deutschland. · Campus Kerckhoff, Universität Gießen, Bad Nauheim, Deutschland. Christian.Hamm@innere.med.uni-giessen.de. · Medizinische Klinik I, Universität Gießen, Klinikstr. 33, 35392, Gießen, Deutschland. Christian.Hamm@innere.med.uni-giessen.de. ·Herz · Pubmed #30328479.

ABSTRACT: In recent years it has been observed with increasing interest that there is a group of patients with electrocardiographic and laboratory features of myocardial infarction (MI) but no obstructive coronary artery disease (<50% diameter stenosis). For this entity the term myocardial infarction with non-obstructive coronary arteries (MINOCA) has been coined. The prevalence of MINOCA is estimated to be 6-9% among patients diagnosed with MI and it is more common in women than men as well as in patients presenting with NSTEMI than in those presenting with STEMI. The MINOCA is a working diagnosis that requires a further diagnostic work-up by invasive techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) or non-invasive imaging with cardiac magnetic resonance imaging (CMRI). When it is ascertained that obstructive coronary artery disease has not been inadvertently overlooked, other coronary disorders, such as plaque rupture or erosion, thrombosis, dissection, spasms or microvascular dysfunction should be evaluated. Furthermore, myocarditis or tako-tsubo cardiomyopathy should be excluded by CMRI as non-coronary causes. The further treatment and prognosis of patients with MINOCA depend on the underlying cause and the final diagnosis.

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