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Coronary Artery Disease: HELP
Articles by Dr. Adnan Kastrati
Based on 127 articles published since 2008
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Between 2008 and 2019, A. Kastrati wrote the following 127 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. 2018

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Petricevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis / Levine, Glenn N / Anonymous3740973. · ·Eur J Cardiothorac Surg · Pubmed #29045581.

ABSTRACT: -- No abstract --

2 Guideline Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. 2018

Byrne, Robert A / Stefanini, Giulio G / Capodanno, Davide / Onuma, Yoshinobu / Baumbach, Andreas / Escaned, Javier / Haude, Michael / James, Stefan / Joner, Michael / Jüni, Peter / Kastrati, Adnan / Oktay, Semih / Wijns, William / Serruys, Patrick W / Windecker, Stephan. ·Deutsches Herzzentrum München, Technische Universität München, Germany. ·EuroIntervention · Pubmed #28948934.

ABSTRACT: A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device -the Absorb bioresorbable vascular scaffold- has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE- mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up.

3 Guideline [2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.] 2017

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Peticevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis. ·Cardiology, Inselspital, Bern. marco.valgimigli@insel.ch. ·Kardiol Pol · Pubmed #29251754.

ABSTRACT: -- No abstract --

4 Guideline Meeting report ESC forum on drug eluting stents, European Heart House, Nice, 27-28 September 2007. 2009

Daemen, Joost / Simoons, Maarten L / Wijns, William / Bagust, Adrian / Bos, Gert / Bowen, James M / Braunwald, Eugene / Camenzind, Edoardo / Chevaliers, Bernard / DiMario, Carlo / Fajadeto, Jean / Gitt, Anselm / Guagliumi, Giulio / Hillege, Hans L / James, Stefan / Jüni, Peter / Kastrati, Adnan / Kloth, Sabine / Kristensen, Steen D / Krucoff, Mitchell / Legrand, Victor / Pfisterer, Matthias / Rothman, Martin / Serruys, Patrick W / Silber, Sigmund / Steg, Philippe G / Tariah, Ibrahim / Wallentin, Lars / Windecker, Stephan W / Aimonetti, A / Allocco, D / Berenger, M / Boam, A / Calle, J P / Campo, G / Carlier, S / de Schepper, J / Di Bisceglie, G / Dobbels, H / Farb, A / Ghislain, J C / Hellbardt, S / ten Hoedt, R / Isaia, C / de Jong, P / Lekehal, M / LeNarz, L / Mhullain, F Ni / Nagai, H / Patteet, A / Paunovic, D / Potgieter, A / Purdy, I / Raveau-Landon, C / Ternstrom, S / Van Wuytswinkel, J / Waliszewski, M / Anonymous830624. ·Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. ·EuroIntervention · Pubmed #19284063.

ABSTRACT: -- No abstract --

5 Editorial Biodegradable-polymer drug-eluting stents: back to the future? 2017

Cassese, Salvatore / Xhepa, Erion / Kastrati, Adnan. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. ·Heart · Pubmed #27628493.

ABSTRACT: -- No abstract --

6 Editorial Bifurcation intervention with a two-stent strategy: can one size fit all? 2016

Colleran, Roisin / Byrne, Robert A / Kastrati, Adnan. ·Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany. · DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Strasse 29, 80802 Munich, Germany. · Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany kastrati@dhm.mhn.de. ·Eur Heart J · Pubmed #27680609.

ABSTRACT: -- No abstract --

7 Editorial Prognosis after revascularization for left main coronary artery disease: insights from the crystal ball. 2015

Byrne, Robert A / Kastrati, Adnan. ·Deutsches Herzzentrum München, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany byrne@dhm.mhn.de. · Deutsches Herzzentrum München, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. ·Eur Heart J · Pubmed #25784753.

ABSTRACT: -- No abstract --

8 Editorial Drug-eluting stents for drug-eluting stent restenosis: stick with the old or switch to a new one? 2014

Kufner, Sebastian / Kastrati, Adnan. ·aISA Research Center, Department of Cardiology, German Heart Center Munich bKlinikum rechts der Isar, Department of Cardiology, Technical University Munich cDZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. ·Coron Artery Dis · Pubmed #25365642.

ABSTRACT: -- No abstract --

9 Editorial A case where the principle of "one question, one answer" may work better. 2012

Tada, Tomohisa / Byrne, Robert A / Kastrati, Adnan. · ·Am Heart J · Pubmed #22305827.

ABSTRACT: -- No abstract --

10 Editorial Is diabetes the achilles' heel of limus-eluting stents? 2011

Kastrati, Adnan / Massberg, Steffen / Ndrepepa, Gjin. · ·Circulation · Pubmed #21859980.

ABSTRACT: -- No abstract --

11 Editorial More deserved focus on diabetic patients. 2011

Ndrepepa, Gjin / King, Lamin / Kastrati, Adnan. · ·Circ Cardiovasc Interv · Pubmed #21505164.

ABSTRACT: -- No abstract --

12 Editorial Is diabetes a leveler of efficacy of DES types? 2010

Kastrati, Adnan. · ·Catheter Cardiovasc Interv · Pubmed #20162698.

ABSTRACT: -- No abstract --

13 Review Percutaneous coronary intervention: balloons, stents and scaffolds. 2018

Colleran, Roisin / Kastrati, Adnan. ·Deutshes Herzzentrum München, Technische Universität München, Lazarettstr 36, 80636, Munich, Germany. · Deutshes Herzzentrum München, Technische Universität München, Lazarettstr 36, 80636, Munich, Germany. kastrati@dhm.mhn.de. · DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. kastrati@dhm.mhn.de. ·Clin Res Cardiol · Pubmed #30039189.

ABSTRACT: In this review, major achievements in the field of percutaneous coronary interventions are delineated with particular focus on Germany's contribution. The review deals with important developments, including the first heart catheterization and coronary angiography, first coronary balloon angioplasty and refinement of the technique, coronary stenting and optimization of adjunctive antithrombotic treatment, drug-eluting stents and balloons, as well as bioresorbable polymeric and metallic drug-eluting scaffolds.

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

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

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

15 Review State of the art: coronary artery stents - past, present and future. 2017

Stefanini, Giulio G / Byrne, Robert A / Windecker, Stephan / Kastrati, Adnan. ·Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. ·EuroIntervention · Pubmed #28844032.

ABSTRACT: The first percutaneous coronary intervention (PCI) was performed in September 1977 by Andreas Grüntzig using a rudimentary balloon angioplasty catheter mounted on a fixed wire. PCI was immediately recognised as a potential breakthrough in cardiovascular medicine, but uptake in clinical practice was limited by unpredictable acute outcomes and a need for surgical standby. The introduction of bare metal stents (BMS) in the 1980s improved procedure reproducibility and clinical outcomes through a permanent scaffolding of the coronary vessel, preventing abrupt occlusion and acute recoil. It was the introduction of drug-eluting stents (DES) at the beginning of this century, however, that allowed PCI to become one of the most frequently performed therapeutic interventions in medicine, primarily by addressing the issue of in-stent restenosis. DES technology has improved considerably since, with iterative developments of the stent metallic backbone, the polymer coating, and the released antiproliferative agents impacting on the safety and efficacy profile of these devices in a meaningful way. Overall, the impressive technological advances in metallic coronary stents have revolutionised the treatment of ischaemic heart disease over the last 40 years. The aim of the present article is to provide an overview of past, present, and future aspects of coronary stent technologies.

16 Review A laboratory association between hemoglobin and VerifyNow P2Y12 reaction unit: A systematic review and meta-analysis. 2017

Kim, Yun Gi / Suh, Jung-Won / Sibbing, Dirk / Kastrati, Adnan / Ko, Young-Guk / Jang, Yangsoo / Cho, Young-Seok / Youn, Tae-Jin / Chae, In-Ho / Choi, Dong-Ju / Kim, Hyo-Soo. ·Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea. · Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea. Electronic address: dasome2@snu.ac.kr. · Ludwig-Maximilians-Universität München, München, Germany. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. · Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea. · Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. ·Am Heart J · Pubmed #28577681.

ABSTRACT: BACKGROUND: VerifyNow P2Y12 assay is used widely to evaluate residual platelet reactivity in patients taking P2Y12 receptor antagonists. However, a laboratory association between VerifyNow P2Y12 reaction unit (PRU) and hemoglobin, which might lead to wrong interpretation of the data, is reported. We performed these systematic review and meta-analysis to clearly define the relationship between PRU and hemoglobin and to elucidate whether the relationship, if any, is a true biological association or is just a laboratory error. METHODS: Through a comprehensive electronic and manual search, 10 studies were selected for the cohort level meta-analysis. Among 10 studies, we were able to retrieve the raw data of 5 studies, and a patient-level meta-analysis was performed. Potential publication bias was searched by funnel plot analysis and was actively adjusted, if present, by trim and fill method. RESULTS: The pooled analysis revealed a significant inverse correlation between PRU and hemoglobin (r=-0.349; P<.001; 10 studies with 4,793 patients). VerifyNow P2Y12 base unit, which reflects off-drug platelet reactivity, was also inversely correlated with hemoglobin (r=-0.526; P<.001; 8 studies with 4,395 patients). % Inhibition (r=0.081; P=.059; 6 studies with 3,832 patients) and ΔPRU (r=-0.037; P=.188; 5 studies with 3,521 patients) were not associated with hemoglobin. A significant inverse association between PRU and hemoglobin was also observed in the patient-level meta-analysis (3,533 patients pooled from 5 studies; r=-0.335; P<.001). Light transmission aggregometry (r=0.160; P=.072; 4 studies with 1,144 patients) and multiple electrode platelet aggregometry (r=-0.029; P=.394; 3 studies with 7,645 patients) showed no significant association with hemoglobin. CONCLUSIONS: A significant inverse association was observed between PRU and hemoglobin which is likely to be a laboratory error. Clinicians should be aware that this association might lead to wrong interpretation of the data.

17 Review Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary. 2015

Byrne, Robert A / Serruys, Patrick W / Baumbach, Andreas / Escaned, Javier / Fajadet, Jean / James, Stefan / Joner, Michael / Oktay, Semih / Jüni, Peter / Kastrati, Adnan / Sianos, George / Stefanini, Giulio G / Wijns, William / Windecker, Stephan. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. · Bristol Heart Institute, Bristol, UK. · Interventional Cardiology, Hospital San Carlos, Madrid, Spain. · Interventional Cardiology, Clinique Pasteur, Toulouse, France. · Clinical Research Center, Uppsala University, Uppsala, Sweden. · CVPath Institute, Inc., Gaithersburg, USA. · Cardio Med Device Consultants, Baltimore, USA. · Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. · AHEPA University Hospital, Thessaloniki, Greece. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Cardiovascular Center O.L.V.Z., Aalst, Belgium. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland stephan.windecker@insel.ch. ·Eur Heart J · Pubmed #26071600.

ABSTRACT: The evaluation for European Union market approval of coronary stents falls under the Medical Device Directive that was adopted in 1993. Specific requirements for the assessment of coronary stents are laid out in supplementary advisory documents. In response to a call by the European Commission to make recommendations for a revision of the advisory document on the evaluation of coronary stents (Appendix 1 of MEDDEV 2.7.1), the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) established a Task Force to develop an expert advisory report. As basis for its report, the ESC-EAPCI Task Force reviewed existing processes, established a comprehensive list of all coronary drug-eluting stents that have received a CE mark to date, and undertook a systematic review of the literature of all published randomized clinical trials evaluating clinical and angiographic outcomes of coronary artery stents between 2002 and 2013. Based on these data, the TF provided recommendations to inform a new regulatory process for coronary stents. The main recommendations of the task force include implementation of a standardized non-clinical assessment of stents and a novel clinical evaluation pathway for market approval. The two-stage clinical evaluation plan includes recommendation for an initial pre-market trial with objective performance criteria (OPC) benchmarking using invasive imaging follow-up leading to conditional CE-mark approval and a subsequent mandatory, large-scale randomized trial with clinical endpoint evaluation leading to unconditional CE-mark. The data analysis from the systematic review of the Task Force may provide a basis for determination of OPC for use in future studies. This paper represents an executive summary of the Task Force's report.

18 Review Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. 2015

Otsuka, Fumiyuki / Byrne, Robert A / Yahagi, Kazuyuki / Mori, Hiroyoshi / Ladich, Elena / Fowler, David R / Kutys, Robert / Xhepa, Erion / Kastrati, Adnan / Virmani, Renu / Joner, Michael. ·CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA. · Deutsches Herzzentrum München, Technische Universitat München, Munich, Germany. · Office of the Chief Medical Examiner, Baltimore, MD, USA. · CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA mjoner@cvpath.org michaeljoner@me.com. ·Eur Heart J · Pubmed #25994755.

ABSTRACT: Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement. In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may occur in months to years following stent placement, whereas atherosclerosis in native coronary arteries develops over decades. Pathologic and clinical imaging studies have demonstrated that neoatherosclerosis occurs more frequently and at an earlier time point in DES when compared with bare metal stents, and increases with time in both types of implant. Early development of neoatherosclerosis has been identified not only in first-generation DES but also in second-generation DES. The mechanisms underlying the rapid development of neoatherosclerosis remain unknown; however, either absence or abnormal endothelial functional integrity following stent implantation may contribute to this process. In-stent plaque rupture likely accounts for most thrombotic events associated with neoatherosclerosis, while it may also be a substrate of in-stent restenosis as thrombosis may occur either symptomatically or asymptomatically. Intravascular optical coherence tomography is capable of detecting neoatherosclerosis; however, the shortcomings of this modality must be recognized. Future studies should assess the impact of iterations in stent technology and risk factor modification on disease progression. Similarly, refinements in imaging techniques are also warranted that will permit more reliable detection of neoatherosclerosis.

19 Review Rationale and design of The Intracoronary Stenting and Antithrombotic Regimen-Testing of a six-week versus a six-month clopidogrel treatment Regimen In Patients with concomitant aspirin and oraL anticoagulant therapy following drug-Eluting stenting (ISAR-TRIPLE) study. 2014

Fiedler, K Anette / Byrne, Robert A / Schulz, Stefanie / Sibbing, Dirk / Mehilli, Julinda / Ibrahim, Tareq / Maeng, Michael / Laugwitz, Karl-Ludwig / Kastrati, Adnan / Sarafoff, Nikolaus. ·Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. Electronic address: anette.fiedler@yahoo.de. · Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. · Deutsches Herzzentrum, Technische Universität, Munich, Germany. · Klinikum der Ludwig-Maximilians-Universität, Munich, Germany. · DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany. · 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany. · Departement of Cardiology, Aarhus University Hospital, Skeby, Aarhus, Denmark. ·Am Heart J · Pubmed #24655693.

ABSTRACT: BACKGROUND: An increasing number of patients undergoing coronary stenting need lifelong anticoagulation and therefore require a triple therapy typically consisting of aspirin, clopidogrel, and a vitamin K antagonist. Triple therapy confers an elevated bleeding risk as compared with dual therapy; however, omission of either antiplatelet or anticoagulation therapy might increase the risk of stent thrombosis or thrombembolic events. Although guidelines recommend a duration of dual antiplatelet therapy of 6 to 12months after drug-eluting stent (DES) implantation, the optimal duration of dual antiplatelet therapy in patients receiving oral anticoagulation is not known. HYPOTHESIS: We postulate that 6-week clopidogrel therapy after DES implantation as compared with 6-month therapy is associated with improved clinical outcomes in patients undergoing DES implantation receiving concomitant aspirin and vitamin K antagonists. STUDY DESIGN: The ISAR-TRIPLE is a randomized, open-label trial that examines the restriction of clopidogrel therapy from 6 months to 6 weeks after DES implantation in the setting of concomitant aspirin and oral anticoagulant. Patients are randomized in a 1:1 fashion to either 6-week or 6-month clopidogrel therapy. The primary end point is a composite of death, myocardial infarction, definite stent thrombosis, stroke, or major bleeding. The secondary end point comprises ischemic and bleeding complications. According to sample size calculations, a total of 600 patients are required to be enrolled. Clinical follow-up is scheduled at 6 weeks and at 6 and 9 months after randomization. SUMMARY: There is clinical equipoise regarding the optimal duration of triple therapy after DES implantation in patients who need vitamin K antagonist therapy. The ISAR-TRIPLE trial aims to test the hypothesis that a 6-week triple therapy compared with a 6-month triple therapy improves net clinical outcomes.

20 Review Drug-coated balloon therapy in coronary and peripheral artery disease. 2014

Byrne, Robert A / Joner, Michael / Alfonso, Fernando / Kastrati, Adnan. ·Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, D-80636 Munich, Germany. · Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, c/ Diego de León 62, Madrid 28006, Spain. ·Nat Rev Cardiol · Pubmed #24189405.

ABSTRACT: Nonstent-based local drug delivery during percutaneous intervention offers potential for sustained antirestenotic efficacy without the limitations of permanent vascular implants. Preclinical studies have shown that effective local tissue concentrations of drugs can be achieved using drug-coated balloon (DCB) catheters. Matrix coatings consisting of a mixture of lipophilic paclitaxel and hydrophilic spacer (excipient) are most effective. Clinical applications most suited to DCB therapy are those for which stent implantation is not desirable or less effective, such as in-stent restenosis, bifurcation lesions, or peripheral artery stenoses. Randomized trials have shown superiority of DCBs over plain-balloon angioplasty for both bare-metal and drug-eluting coronary in-stent restenosis, and similar efficacy as repeat stenting with a drug-eluting stent (DES). Bycontrast, randomized trials of DCBs in de novo coronary stenosis have, to date, not shown similar efficacy to standard-of-care DES therapy. In peripheral artery disease, DCB therapy has proven superior to plain-balloon angioplasty for treatment of de novo femoropoliteal and below-the-knee disease, and shown promising results for in-stent restenosis. Overall, however, despite many years of clinical experience with DCBs, the number of large, high-quality, randomized clinical trials is low, and further data are urgently needed across the spectrum of clinical indications.

21 Review Clinical impact of extended dual antiplatelet therapy after percutaneous coronary interventions in the drug-eluting stent era: a meta-analysis of randomized trials. 2012

Cassese, Salvatore / Byrne, Robert A / Tada, Tomohisa / King, Lamin A / Kastrati, Adnan. ·Deutsches Herzzentrum, Technische Universität, Lazaretstr. 36, Munich, Germany. ·Eur Heart J · Pubmed #23091199.

ABSTRACT: AIMS: The aim of this study was to evaluate benefits and risks of extending dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in the drug-eluting stent era. METHODS AND RESULTS: We searched electronic databases (Medline, EMBASE, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, chapters in books, and proceedings of advisory panels for the US Food and Drug Administration, for randomized controlled trials investigating the clinical impact of extending DAPT duration in patients undergoing PCI. The primary endpoint was all-cause death. The secondary endpoints were myocardial infarction (MI), stent thrombosis (ST), cerebrovascular accidents (CVAs), and thrombolysis in myocardial infarction (TIMI) major bleeding. We included four trials that randomized 8231 patients (50.2%, extended DAPT duration vs. 49.8%, control duration). A total of 8158 patients (99.1%) were available for final analyses. The median DAPT duration was 16.8 vs. 6.2 months for the extended DAPT and control groups, respectively. At follow-up (median 16.8 months) extending DAPT duration did not reduce all-cause death [odds ratio (95% confidence interval) = 1.15 (0.85-1.54), P = 0.36], MI [0.95 (0.66-1.36), P = 0.77], ST [0.88 (0.43-1.81), P = 0.73], or CVAs [1.51 (0.92-2.47), P = 0.10]. Conversely, extended DAPT duration clearly increased the risk of TIMI major bleeding [2.64 (1.31-5.30), P = 0.006]. CONCLUSIONS: The extension of DAPT duration after percutaneous coronary interventions may increase the risk of bleeding without reducing ischaemic events. These results need corroboration from large ongoing trials.

22 Review Two zotarolimus-eluting stent generations: a meta-analysis of 12 randomised trials versus other limus-eluting stents and an adjusted indirect comparison. 2012

Cassese, Salvatore / Ndrepepa, Gjin / King, Lamin A / Tada, Tomohisa / Fusaro, Massimiliano / Kastrati, Adnan. ·Deutsches Herzzentrum, Technische Universität, Lazaretstr. 36, Munich 80636, Germany. ·Heart · Pubmed #22949487.

ABSTRACT: OBJECTIVE: To evaluate efficacy and safety of two zotarolimus-eluting stent generations versus other limus-eluting stents (LES), and to compare Resolute zotarolimus-eluting stents (R-ZES) with Endeavor zotarolimus-eluting stents (E-ZES). BACKGROUND: The performance of zotarolimus-eluting stents versus other LES, and the possible improvements of R-ZES versus E-ZES still remain to be defined. METHODS: We undertook a meta-analysis of trials in which patients were randomly assigned to percutaneous coronary interventions (PCI) with R-ZES versus LES, or with E-ZES versus LES, as well as an indirect comparison of R-ZES versus E-ZES, with LES as common comparator. The primary efficacy endpoint was ischaemia-driven target vessel revascularisation (ID-TVR); the primary safety endpoints were myocardial infarction (MI), cardiac death and cumulative definite/probable stent thrombosis (ST). RESULTS: Overall, 13'709 patients were assigned to PCI with R-ZES versus LES (n=7185) or with E-ZES versus LES (n=6524). The risk of ID-TVR (OR (95% CI)=1.06 (0.90 to 1.25), p=0.47), MI (1.00 (0.81 to 1.25), p=0.97), cardiac death (0.99 (0.69 to 1.42), p=0.96) and ST (1.18 (0.68 to 2.03), p=0.56) did not differ between R-ZES and LES. Patients receiving E-ZES were more likely to undergo ID-TVR as compared with those receiving LES (1.95 (1.40 to 2.73), p<0.0001). The risk of MI (0.91 (0.54 to 1.54), p=0.73), cardiac death (1.02 (0.54 to 1.91), p=0.96) and ST (1.10 (0.50 to 2.44), p=0.81) was similar between E-ZES and LES. At indirect comparison, PCI with R-ZES versus E-ZES reduced the risk of ID-TVR (0.54 (0.37 to 0.78), p=0.001), without increasing MI (1.09 (0.62 to 1.93), p=0.74), cardiac death (0.97 (0.46 to 2.00), p=0.93) and ST (1.07 (0.40 to 2.80), p=0.88). CONCLUSIONS: The antirestenotic efficacy of Resolute zotarolimus-eluting stents is superior to Endeavor zotarolimus-eluting stents and similar to other limus-eluting stents. Endeavor zotarolimus-eluting stents increase the risk of reinterventions as compared with other limus-eluting stents. First and second-generation zotarolimus-eluting stents have similar thrombogenicity compared with other limus-eluting stents.

23 Review Multivessel percutaneous coronary intervention: a review of the literature and fallacies in its interpretation. 2008

Mylotte, D / Byrne, R A / Iijima, R / Kastrati, A. ·Deutsches Herzzentrum, Technische Universität Munich, Germany. ·Minerva Cardioangiol · Pubmed #18813185.

ABSTRACT: Since its inception in the 1960s, coronary revascularization has established itself as a fundamental therapy for treating the acute and chronic manifestations of atherosclerotic coronary disease. Catheter-based techniques were realized in the late 1970s and have evolved from balloon dilatation of simple, discrete stenoses to complex, multivessel interventions across the spectrum of coronary disease presentations. In retrospect, there were two defining technological developments the introduction of coronary stenting which enabled more stable acute outcomes and the evolution of drug-eluting stents which ameliorated the effect of neointimal hyperplasia the dominant cause of delayed loss of efficacy. The role of catheter-based intervention in multivessel disease is well established in the treatment of ST-elevation myocardial infarction and acute coronary syndromes. On the contrary, in the arena of in stable coronary disease, its utility is keenly debated. The pace of development in cardiovascular pharmacology has rendered early investigation of best treatment strategies largely obsolete, while newer revascularization techniques have successfully extended the remit of catheter-based multivessel intervention strategies to include left main stem disease, bifurcation stenosis and chronic occlusions. Consequently complete revascularization is now available via a percutaneous approach and conventional beliefs relating to choice of revascularization strategy deserve re-assessment. The authors present a contemporary review of the literature and a challenge against fallacies in its interpretation.

24 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.

25 Clinical Trial Ticagrelor versus prasugrel in patients with high on-clopidogrel treatment platelet reactivity after PCI: The ISAR-ADAPT-PF study. 2016

Bernlochner, Isabell / Mayer, Katharina / Orban, Martin / Morath, Tanja / Jaitner, Juliane / Rössner, Lisa / Gross, Lisa / Laugwitz, Karl-Ludwig / Kastrati, Adnan / Sibbing, Dirk. ·a Medizinische Klinik und Poliklinik, Klinikum rechts der Isar , Technische Universität München , Munich , Germany. · b Deutsches Herzzentrum München , Technische Universität München , Munich , Germany. · c Department of Cardiology , Ludwig-Maximilians-Universität , Munich , Germany. · d DZHK (German Centre for Cardiovascular Research) , partner site Munich Heart Alliance , Munich , Germany. ·Platelets · Pubmed #27275651.

ABSTRACT: Patients with high on-treatment platelet reactivity (HTPR) on clopidogrel are at high risk for adverse cardiovascular events after percutaneous coronary intervention (PCI). The aim of the ISAR-ADAPT-PF study was to assess the antiplatelet efficacy of ticagrelor versus prasugrel in patients with HTPR on clopidogrel. In a prospective and randomized clinical study, 70 patients with HTPR on clopidogrel loading dose (LD) within 24 h post PCI were assigned to receive either ticagrelor [180 mg LD followed by 90 mg maintenance dose (MD) twice daily] or prasugrel (60 mg LD followed by 10 mg MD once daily). The adenosine diphosphate-induced platelet aggregation assessed on the Multiplate analyzer on day 2 after randomization (primary end point) was as follows: the mean difference between the two treatment groups was 6 aggregation units (AU) × min with an upper 95% confidence interval (CI) of 41 AU × min, which was greater than the predefined noninferiority margin of 18 AU × min (P for noninferiority = 0.29). However, no significant differences in absolute platelet reactivity levels between ticagrelor- versus prasugrel-treated patients at that time point were observed (138 ± 100 AU × min vs. 132 ± 64 AU × min, P for superiority = 0.77). In conclusion, neither drug was statistically more effective for inhibition of platelet aggregation in patients with HTPR on clopidogrel post PCI, although the study could not formally demonstrate the assumed noninferiority of ticagrelor versus prasugrel.

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