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Coronary Artery Disease: HELP
Articles by Michael Maeng
Based on 66 articles published since 2010
(Why 66 articles?)
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Between 2010 and 2020, M. Maeng wrote the following 66 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 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.

2 Clinical Trial Serial Multimodality Imaging and 2-Year Clinical Outcomes of the Novel DESolve Novolimus-Eluting Bioresorbable Coronary Scaffold System for the Treatment of Single De Novo Coronary Lesions. 2016

Abizaid, Alexandre / Costa, Ricardo A / Schofer, Joachim / Ormiston, John / Maeng, Michael / Witzenbichler, Bernhard / Botelho, Roberto V / Costa, J Ribamar / Chamié, Daniel / Abizaid, Andrea S / Castro, Juliana P / Morrison, Lynn / Toyloy, Sara / Bhat, Vinayak / Yan, John / Verheye, Stefan. ·Instituto Dante Pazzanese, São Paulo, Brazil. Electronic address: aabizaid@uol.com.br. · Instituto Dante Pazzanese, São Paulo, Brazil. · Universitäres Herz-und Gefäβzentrum, Hamburg, Germany. · Mercy Angiography Unit, Auckland, New Zealand. · Aarhus University Hospital, Aarhus, Denmark. · Charite Benjamin Franklin Campus, Med. Klinik II, Berlin, Germany. · Instituto do Coração do Triângulo Mineiro, Uberlândia, Brazil. · Cardiovascular Research Center, São Paulo, Brazil. · Elixir Medical Corporation, Sunnyvale, California. · ZNA Middelheim, Antwerp, Belgium. ·JACC Cardiovasc Interv · Pubmed #27013155.

ABSTRACT: OBJECTIVES: This study sought to report the late multimodality imaging and clinical outcomes of the novel poly-l-lactic-acid-based DESolve novolimus-eluting bioresorbable coronary scaffold for the treatment of de novo coronary lesions. BACKGROUND: Bioresorbable scaffolds are an alternative to drug-eluting metallic stents and provide temporary vascular scaffolding, which potentially may allow vessel restoration and reduce the risk of future adverse events. METHODS: Overall, 126 patients were enrolled at 13 international sites between November 2011 and June 2012. The primary endpoint was in-scaffold late lumen loss at 6 months. Major adverse cardiac events, the main safety endpoint, were defined as the composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization. All patients underwent angiography at 6 months. Serial intravascular ultrasound and optical coherence tomography were performed in a subset of patients. RESULTS: The scaffold device success rate was 97% (n = 122 of 126), and procedural success was 100% (n = 122 of 122). The major adverse cardiac event rate was 3.3% (n = 4 of 122) at 6 months and 7.4% (n = 9 of 122) at 24 months, including 1 probable stent thrombosis within the first month. At 6-month angiographic follow-up, in-scaffold late lumen loss was 0.20 ± 0.32 mm. Paired intravascular ultrasound analysis demonstrated a significant increase in vessel, lumen and scaffold dimensions between post-procedure and 6-month follow-up, and strut-level optical coherence tomography analysis showed full strut coverage in 99 ± 1.7%. CONCLUSIONS: Our results showed favorable performance of the DESolve scaffold, effective inhibition of neointimal hyperplasia, and for the first time, early luminal and scaffold growth at 6 months with sustained efficacy and safety through 2 years. (Elixir Medical Clinical Evaluation of the DESolve Novolimus Eluting Bioresorbable Coronary Scaffold System-The DESolve Nx Trial; NCT02086045).

3 Clinical Trial One-year clinical and angiographic results of hybrid coronary revascularization. 2015

Modrau, Ivy S / Holm, Niels R / Mæng, Michael / Bøtker, Hans E / Christiansen, Evald H / Kristensen, Steen D / Lassen, Jens F / Thuesen, Leif / Nielsen, Per H / Anonymous5220844. ·Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address: modrau@mail1.stofanet.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark. ·J Thorac Cardiovasc Surg · Pubmed #26432721.

ABSTRACT: OBJECTIVE: To evaluate 1-year clinical and angiographic results after hybrid coronary revascularization (HCR) combining off-pump left internal mammary artery (LIMA) grafting through an inferior J-hemisternotomy with percutaneous coronary intervention (PCI). METHODS: Prospective, single-arm clinical feasibility study including 100 consecutive patients with multivessel disease undergoing staged HCR. The primary endpoint was the major adverse cardiac and cerebrovascular event rate at 1 year. Secondary endpoints included 1-year all-cause death, stroke, myocardial infarction, repeat revascularization, and angiographic graft and stent patency. RESULTS: One-year clinical follow-up data were available in all patients. The primary endpoint was met by 20 patients (20%). Individual endpoints were as follows: 1 death due to heart failure; 1 stroke, 2 procedure-related myocardial infarctions; and 1 spontaneous myocardial infarction during follow-up. A total of 16 patients underwent repeat revascularization: 5 surgical reinterventions during the index hospitalization for angiographically suspected internal mammary artery graft dysfunction, and 3 repeat PCIs. Only 1 patient had evidence of ischemia. After discharge, PCI was performed in 6 patients who had recurrent angina, and in 2 asymptomatic patients who had angiographic restenosis. At the 1-year angiographic follow-up, 87 of 89 (98%) patients had patent internal mammary artery grafts. Angiographic restenosis was present in 10 of 100 lesions treated by PCI. CONCLUSIONS: Angiographically controlled HCR was associated with a high repeat revascularization rate. The 1-year 98% LIMA-graft patency rate, and low risk of death and stroke, seem promising for the long-term outcome. Non-left anterior descending coronary artery lesion revascularization remains a challenge.

4 Clinical Trial Comparison of outcomes in patients with versus without diabetes mellitus after revascularization with everolimus- and sirolimus-eluting stents (from the SORT OUT IV trial). 2012

Jensen, Lisette Okkels / Thayssen, Per / Junker, Anders / Maeng, Michael / Tilsted, Hans-Henrik / Kaltoft, Anne / Hansen, Knud Nørregaard / Christiansen, Evald Høj / Kristensen, Steen Dalby / Ravkilde, Jan / Madsen, Morten / Sørensen, Henrik Toft / Thuesen, Leif / Lassen, Jens Flensted. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk ·Am J Cardiol · Pubmed #22959714.

ABSTRACT: Diabetes is associated with increased risk of major adverse cardiac events (MACEs) after percutaneous coronary intervention. The purpose of this substudy of the SORT OUT IV trial was to compare clinical outcomes in patients with and without diabetes mellitus treated with everolimus-eluting stents (EESs) or sirolimus-eluting stents (SESs). In total 2,774 patients (390 with diabetes, 14.1%) were randomized to stent implantation with EESs (n = 1,390, diabetes in 14.0%) or SESs (n = 1,384, diabetes in 14.2%). Randomization was stratified by presence/absence of diabetes. The primary end point was MACEs, a composite of cardiac death, myocardial infarction, definite stent thrombosis, or target vessel revascularization within 18 months. MACEs were higher in diabetic than in nondiabetic patients (13.1% vs 6.4%, hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.51 to 2.86). In diabetic patients, MACEs were seen in 10.3% of those treated with EESs and in 15.8% of those treated with SESs (HR 0.63, 95% CI 0.36 to 1.11). In nondiabetic patients, MACEs occurred in 6.6% of EES-treated and in 6.3% SES-treated patients (HR 1.06, 95% CI 0.77 to 1.46). In diabetics, cardiac death occurred in 3.1% of EES-treated and in 4.6% of SES-treated patients (HR 0.67, 95% CI 0.24 to 1.89), myocardial infarction occurred in 0.5% of EES-treated and in 3.6% of SES-treated patients (HR 0.14, 95% CI 0.02 to 1.16), and clinically driven target lesion revascularization was needed in 3.1% of EES-treated and in 7.7% of SES-treated patients (HR 0.40, 95% CI 0.15 to 1.02). No interaction between diabetes status and type of drug-eluting stent was found for the end points. In conclusion, patients with diabetes have higher MACE rates than nondiabetics. No significant differences in safety or efficacy outcomes after EES or SES implantation were present in nondiabetic or diabetic patients.

5 Clinical Trial Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. 2011

Niemelä, Matti / Kervinen, Kari / Erglis, Andrejs / Holm, Niels R / Maeng, Michael / Christiansen, Evald H / Kumsars, Indulis / Jegere, Sanda / Dombrovskis, Andis / Gunnes, Pål / Stavnes, Sindre / Steigen, Terje K / Trovik, Thor / Eskola, Markku / Vikman, Saila / Romppanen, Hannu / Mäkikallio, Timo / Hansen, Knud N / Thayssen, Per / Aberge, Lars / Jensen, Lisette O / Hervold, Anders / Airaksinen, Juhani / Pietilä, Mikko / Frobert, Ole / Kellerth, Thomas / Ravkilde, Jan / Aarøe, Jens / Jensen, Jan S / Helqvist, Steffen / Sjögren, Iwar / James, Stefan / Miettinen, Heikki / Lassen, Jens F / Thuesen, Leif / Anonymous1020682. ·Division of Cardiology, Department of Internal Medicine, University of Oulu, Finland. matti.niemela@ppshp.fi ·Circulation · Pubmed #21173348.

ABSTRACT: BACKGROUND: It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with and without FKBD. METHODS AND RESULTS: We randomized 477 patients with a bifurcation lesion to FKBD (n=238) or no FKBD (n=239) after MV stenting. The primary end point was major adverse cardiac events: cardiac death, non-procedure-related index lesion myocardial infarction, target lesion revascularization, or stent thrombosis within 6 months. The 6-month major adverse cardiac event rates were 2.1% and 2.5% (P=1.00) in the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times were longer and more contrast media was needed in the FKBD group than in the no-FKBD group. Three hundred twenty-six patients had a quantitative coronary assessment. At 8 months, the rate of binary (re)stenosis in the entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3% (P=0.11), in the MV was 3.1% versus 2.5% (P=0.68), and in the side branch was 7.9% versus 15.4% (P=0.039) in the FKBD versus no-FKBD groups, respectively. In patients with true bifurcation lesions, the side branch restenosis rate was 7.6% versus 20.0% (P=0.024) in the FKBD and no-FKBD groups, respectively. CONCLUSIONS: MV stenting strategies with and without FKBD were associated with similar clinical outcomes. FKBD reduced angiographic side branch (re)stenosis, especially in patients with true bifurcation lesions. The simple no-FKBD procedures resulted in reduced use of contrast media and shorter procedure and fluoroscopy times. Long-term data on stent thrombosis are needed. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00914199.

6 Article Ten-Year Outcomes of Sirolimus-Eluting Versus Zotarolimus-Eluting Coronary Stents in Patients With Versus Without Diabetes Mellitus (SORT OUT III). 2020

Olesen, Kevin K W / Pareek, Manan / Madsen, Morten / Jensen, Lisette O / Christiansen, Evald H / Thuesen, Leif / Lassen, Jens F / Kristensen, Steen Dalby / Bøtker, Hans Erik / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kevole@clin.au.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg Hospital, Aalborg, Denmark. ·Am J Cardiol · Pubmed #31796208.

ABSTRACT: We compared 10-year clinical outcomes in diabetes and nondiabetes patients treated with Endeavor zotarolimus-eluting (ZES) or Cypher sirolimus-eluting coronary stents (SES). A total of 1,162 patients were randomized to ZES (169 with diabetes) and 1,170 patients were randomized to SES (168 with diabetes). Patients were further stratified by diabetes status at the time of inclusion. A subgroup of patients with diabetes (n = 88) underwent angiographic re-evaluation 10 months after stent implantation. End points included a combined end point of death or myocardial infarction, and the individual end points of death, myocardial infarction, and revascularization. In patients with diabetes, we found no difference in the combined end point (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.53 to 1.24), death (OR 0.80, 95% CI 0.51 to 1.25), or in MI (OR 1.07, 95% CI 0.60 to 1.91). However, diabetics with ZES more frequently underwent coronary revascularization compared with SES patients (OR 1.93, 95% CI 1.05 to 3.66). In patients without diabetes, ZES and SES had similar 10-year rates of all end points (death: OR 1.13, 95% CI 0.93 to 1.39; MI: OR 0.80, 95% CI 0.61 to 1.05; revascularization: OR 0.81, 95% CI 0.61 to 1.09). Landmark analysis from 5 to 10 years showed no difference in outcomes between SES and ZES in either subgroup. In conclusion, at 10 years, SES and ZES performed similarly in patients with and without diabetes. Although coronary revascularization was more prevalent in diabetes patients with ZES, this may, in part, have been related to the angiographic follow-up that was offered to a subgroup of diabetes patients.

7 Article Diabetes Mellitus Is Associated With Increased Risk of Ischemic Stroke in Patients With and Without Coronary Artery Disease. 2019

Olesen, Kevin K W / Madsen, Morten / Gyldenkerne, Christine / Thrane, Pernille G / Würtz, Morten / Thim, Troels / Jensen, Lisette O / Eikelboom, John / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·From the Department of Cardiology (K.K.W.O., C.G., P.G.T., T.T., H.E.B., M. Maeng), Aarhus University Hospital, Denmark. · Department of Clinical Epidemiology (K.K.W.O., M. Madsen, H.T.S.), Aarhus University Hospital, Denmark. · Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark (M.W.). · Department of Cardiology, Odense University Hospital, Denmark (L.O.J.). · Population Health Research Institute, Hamilton Health Sciences and McMaster University, Ontario, Canada (J.E.). ·Stroke · Pubmed #31690249.

ABSTRACT: Background and Purpose- Diabetes mellitus (DM) and non-DM patients without coronary artery disease (CAD) have a similar low risk of myocardial infarction after coronary angiography. The risk of ischemic stroke in DM patients dependent on CAD status is less explored. We examined whether DM patients without CAD have a risk of ischemic stroke similar to that in patients with neither DM nor CAD. Methods- We conducted a cohort study of patients who underwent coronary angiography between 2004 and 2012 in Western Denmark. Patients diagnosed with previous ischemic stroke or transient ischemic attack were excluded. Patients were stratified according to the presence of DM and CAD. Follow-up started 30 days after coronary angiography. We computed event rates and adjusted incidence rate ratios using patients without DM or CAD as reference. We examined the trend between CAD extent and ischemic stroke in patients with DM. Results- A total of 81 909 patients were included. Median follow-up was 3.8 years. Patients with both DM and CAD were at the highest risk of ischemic stroke (1.32 events per 100 person-years; adjusted incidence rate ratio, 2.00 [95% CI, 1.72-2.32]). Patients with CAD alone (0.77 events per 100 person-years; adjusted incidence rate ratio, 1.27 [95% CI, 1.12-1.44]) or DM alone (0.95 events per 100 person-years; adjusted incidence rate ratio, 1.74 [95% CI, 1.42-2.15]) were at intermediate risk, whereas patients with neither DM nor CAD (0.52 events per 100 person-years) were at the lowest risk. Among patients with DM, extent of CAD was further predictive of risk (

8 Article Everolimus-Eluting Versus Biolimus-Eluting Coronary Stent Implantation in Patients With and Without Diabetes Mellitus. 2019

Gyldenkerne, Christine / Olesen, Kevin K W / Jensen, Lisette O / Junker, Anders / Veien, Karsten T / Terkelsen, Christian J / Kristensen, Steen D / Thim, Troels / Jensen, Svend E / Raungaard, Bent / Aaroe, Jens / Kahlert, Johnny / Villadsen, Anton B / Bøtker, Hans Erik / Christiansen, Evald H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: michael.maeng@ki.au.dk. ·Am J Cardiol · Pubmed #31279405.

ABSTRACT: Diabetes mellitus is associated with a higher risk of target lesion revascularization after percutaneous coronary intervention. We compared clinical outcomes in patients with and without diabetes mellitus, treated with everolimus-eluting stents (EES; Synergy; Boston Scientific, Marlborough, Massachusetts) or biolimus-eluting stents (BES; BioMatrix NeoFlex; Biosensors Interventional Technologies Pte Ltd., Singapore). In total, 2,764 patients were randomized to stent implantation with EES (n = 1,385, diabetes: n = 250) or the BES (n = 1,379, diabetes: n = 262), stratified by gender and diabetes. The primary end point, target lesion failure (TLF), was a composite of cardiac death, target-lesion myocardial infarction, or target lesion revascularization at 12 months. Secondary end points included individual components of TLF, all-cause death, and stent thrombosis. TLF was 2.1% lower in the EES versus the BES groups in patients with diabetes (3.6% vs 5.7%; rate ratios 0.61, 95% confidence interval [CI] 0.27 to 1.41) and similar in patients without diabetes (4.1% vs 4.0%; rate ratios 0.99, 95% CI 0.66 to 1.51). In patients with diabetes, the point estimates of the individual components of TLF also favored the EES but CIs were wide. No interaction between stent type and presence of diabetes was found. The current subgroup analysis found that a thin-strut EES as compared with a thicker strut BES had a numerically lower TLF rate in patients with diabetes, but the subgroup analysis was underpowered for definite conclusions.

9 Article Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. 2019

Olesen, Kevin K W / Riis, Anders H / Nielsen, Lene H / Steffensen, Flemming H / Nørgaard, Bjarne L / Jensen, Jesper M / Poulsen, Per L / Thim, Troels / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark. · Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark. · Departments of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #31220229.

ABSTRACT: AIMS: We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. METHODS AND RESULTS: A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71-2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79-3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14-9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. CONCLUSION: In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

10 Article Procedural findings and early healing response after implantation of a self-apposing bioresorbable scaffold in coronary bifurcation lesions. 2019

Holck, Emil Nielsen / Fox-Maule, Camilla / Barkholt, Trine Ørhøj / Jakobsen, Lars / Tu, Shengxian / Maeng, Michael / Dijkstra, Jouke / Christiansen, Evald Høj / Holm, Niels Ramsing. ·Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Wenxuan Building, 800 Dongchuan RD, Minhang District, Shanghai, China. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. · Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. niels.holm@clin.au.dk. ·Int J Cardiovasc Imaging · Pubmed #31053981.

ABSTRACT: We aimed to evaluate feasibility, early healing and self-correcting properties of the Desolve 150 bioresorbable scaffold (BRS) implanted in bifurcation lesions, using the simple, provisional side branch (SB) stenting technique. BIFSORB pilot was a proof-of-concept study enrolling 10 patients with stable angina pectoris and a bifurcation lesion with SB ≥ 2.5 mm and less than 50% diameter stenosis. Procedure and 1-month outcome was evaluated by optical coherence tomography (OCT) to assess scaffold performance and healing patterns. Nine patients were treated with Desolve 150 BRS and one delivery to the target bifurcation failed. Thrombus formation in the jailed SB ostium was seen in three cases, but was completely resolved at 1-month. OCT confirmed acute self-correcting properties. No clinical events were reported after six months. Scaffold diameter by OCT increased in the proximal main vessel from 3.09 ± 0.16 mm to 3.34 ± 0.18 mm (p = 0.01) and in distal main vessel from 2.82 ± 0.26 mm to 3.02 ± 0.29 mm (p < 0.01) at one-month follow-up. SB ostial diameter stenosis improved from 42 ± 15% to 34 ± 12% (p = 0.01). Malapposition was effectively reduced after 1 month from 4.1 (1.4; 6.1)% to 0.1 (0; 0.6)% (p = 0.002). Treatment of bifurcation lesions using Desolve 150 BRS was feasible except for a delivery failure and unsettling thrombus formation behind jailing SB struts, which was completely resolved at 1-month. Self-correcting and even self-expanding properties were confirmed.

11 Article Influence of Cardiac CT based disease severity and clinical symptoms on the diagnostic performance of myocardial perfusion. 2019

Nissen, L / Winther, S / Westra, J / Ejlersen, J A / Isaksen, C / Rossi, A / Holm, N R / Urbonaviciene, G / Gormsen, L C / Madsen, L H / Christiansen, E H / Maeng, M / Knudsen, L L / Frost, L / Brix, L / Bøtker, H E / Petersen, S E / Bøttcher, M. ·Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark. lounisse@rm.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Nuclear Medicine, Hospital Unit West Jutland, Herning, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Biomedical Sciences, Humanitas University, Milan, Italy. · Department of Diagnostic Imaging, Humanitas Research Hospital, Milan, Italy. · Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark. · William Harvey Research Institute, Queen Mary University of London, London, UK. · St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK. ·Int J Cardiovasc Imaging · Pubmed #31016502.

ABSTRACT: We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.

12 Article Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease. 2019

Gyldenkerne, Christine / Olesen, Kevin Kris Warnakula / Madsen, Morten / Thim, Troels / Jensen, Lisette Okkels / Raungaard, Bent / Sørensen, Henrik Toft / Bøtker, Hans Erik / Maeng, Michael. ·1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · 3 Department of Cardiology, Odense University Hospital, Odense, Denmark. · 4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. ·Diab Vasc Dis Res · Pubmed #30939916.

ABSTRACT: OBJECTIVE: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. METHODS: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. RESULTS: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27-1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27-2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61-8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40-12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51-17.82). CONCLUSION: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

13 Article External applicability of the COMPASS trial: the Western Denmark Heart Registry. 2019

Würtz, Morten / Olesen, Kevin Kris Warnakula / Thim, Troels / Kristensen, Steen Dalby / Eikelboom, John W / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark. · Department of Cardiology, Regional Hospital West Jutland, Gl. Landevej 61, DK Herning, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK Aarhus, Denmark. · Department of Clinical Medicine, Faculty of Health, Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK Aarhus, Denmark. · Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton Street East, Ontario, Canada. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #30916315.

ABSTRACT: AIMS: In the COMPASS trial, combined aspirin and rivaroxaban treatment reduced ischaemic events in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We estimated the proportion of COMPASS eligible patients among unselected patients undergoing coronary angiography (CAG) and compared outcome rates among COMPASS eligible and non-eligible patients. METHODS AND RESULTS: We applied the COMPASS study criteria on patients undergoing CAG in Western Denmark (2004-11). Both COMPASS eligible and non-eligible patients had CAD/PAD and met no exclusion criteria, but only COMPASS eligible patients met the inclusion criteria. We assessed the COMPASS primary endpoint of cardiovascular death, ischaemic stroke, haemorrhagic stroke, or myocardial infarction (MI). We computed event rates and adjusted incidence rate ratios (aIRRs). Of 80 071 patients undergoing CAG, 27 939 did not have CAD or PAD and were not considered. Of the 52 132 patients remaining, 11 930 were COMPASS eligible. Rates of the primary endpoint were 4.8 (95% confidence interval 4.6-5.0) events per 100 person-years among COMPASS eligible patients and 2.3 (2.2-2.4) among COMPASS non-eligible patients [aIRR 1.7 (1.6-1.9)]. COMPASS eligible patients also had higher risks of cardiovascular death [aIRR 2.5 (2.1-3.0)], ischaemic stroke [aIRR 1.4 (1.2-1.6)], and MI [aIRR 1.9 (1.7-2.1)]. CONCLUSION: In this all-comers CAG cohort, 15% were eligible for combined aspirin and rivaroxaban treatment. COMPASS eligible patients had up to 2.5-fold higher rates of cardiovascular events than non-eligible patients. The higher incidence of ischaemic events in COMPASS eligible patients highlights an unmet need for additional preventive measures.

14 Article Predicting stroke in patients without atrial fibrillation. 2019

Steensig, Kamilla / Olesen, Kevin K W / Thim, Troels / Nielsen, Jens C / Madsen, Morten / Jensen, Svend E / Jensen, Lisette O / Kristensen, Steen D / Lip, Gregory Y H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Eur J Clin Invest · Pubmed #30883728.

ABSTRACT: BACKGROUND: Only few studies in selected cohorts have examined whether the CHA MATERIALS AND METHODS: Patients with coronary angiography performed between 2004 and 2012 were grouped according to CHA RESULTS: In total, 78 233 patients were included with group sizes varying between 8299 (CHA CONCLUSIONS: Among patients undergoing coronary angiography, the CHA

15 Article Comparison of Frequency of Ischemic Stroke in Patients With Versus Without Coronary Heart Disease and Without Atrial Fibrillation. 2019

Olesen, Kevin Kris Warnakula / Steensig, Kamilla / Madsen, Morten / Thim, Troels / Jensen, Lisette Okkels / Raungaard, Bent / Eikelboom, John / Kristensen, Steen Dalby / Bøtker, Hans Erik / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kevole@clin.au.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. ·Am J Cardiol · Pubmed #30389089.

ABSTRACT: Recent trials of antithrombotic therapy in patients with coronary artery disease (CAD) have demonstrated substantial reductions in ischemic stroke. Our aim was to examine ischemic stroke risk in patients with CAD and to identify those at highest risk. We examined ischemic stroke risk in patients without atrial fibrillation who underwent coronary angiography between 2004 and 2012. Patients were stratified according to presence or absence of CAD and further stratified by extent of CAD (0 vessel disease [VD], 1 VD, 2 VD, 3 VD, and diffuse VD). End points were composites of ischemic stroke, transient ischemic attack (TIA), and systemic embolism, as well as major adverse cardiovascular and cerebrovascular events (MACCE) defined as cardiac death, myocardial infarction, plus ischemic stroke, TIA, and systemic embolism. Adjusted incidence rate ratios (IRRs) were estimated. A total of 68,829 patients were included, 25,032 had 0 VD, 4,736 had diffuse VD, 18,471 had 1 VD, 10,588 had 2 VD, and 10,002 had 3 VD. Median follow-up was 4.0 years. CAD extent was associated with an increased risk of stroke, TIA, and systemic embolism (1 VD: adjusted IRR 1.02, 95% confidence interval [CI] 0.90 to 1.16; diffuse VD: adjusted IRR 1.22, 95% CI 1.02 to 1.47; 2 VD: adjusted IRR 1.28, 95% CI 1.12 to 1.45; 3 VD: adjusted IRR 1.37, 95% CI 1.20 to 1.55) compared with patients with 0 VD. Presence and extent of CAD were also associated with MACCE. In conclusion, CAD is associated with an increased risk of stroke, TIA, and systemic embolism and MACCE in patients without atrial fibrillation, and patients with coronary multi-VD are at highest risk and may be candidates for treatment strategies aiming at reducing ischemic stroke incidence.

16 Article Impact of diabetes on clinical outcomes after revascularization with sirolimus-eluting and biolimus-eluting stents with biodegradable polymer from the SORT OUT VII trial. 2019

Ellert, Julia / Christiansen, Evald Høj / Maeng, Michael / Raungaard, Bent / Jensen, Svend Eggert / Kristensen, Steen Dalby / Veien, Karsten Tange / Junker, Anders Bo / Jakobsen, Lars / Aarøe, Jens / Terkelsen, Christian Juhl / Kahlert, Johnny / Villadsen, Anton Boel / Bøtker, Hans Erik / Jensen, Lisette Okkels. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark. ·Catheter Cardiovasc Interv · Pubmed #30244533.

ABSTRACT: OBJECTIVES: In this substudy of the SORT OUT VII trial, the clinical outcomes among patient with diabetes mellitus treated with Orsiro sirolimus-eluting stent (O-SES; Biotronik, Bülach, Switzerland) or Nobori biolimus-eluting stent (N-BES; Terumo, Tokyo, Japan) were compared. BACKGROUND: Diabetes is associated with increased risk of target lesion failure (TLF) after percutaneous coronary intervention. METHODS: In total, 2525 patients were randomized to stent implantation with O-SES (n = 1261, diabetes: n = 236) or N-BES (n = 1264, diabetes: n = 235). The primary endpoint, TLF, was a composite of cardiac death, target-lesion myocardial infarction (MI), or target lesion revascularization (TLR) within 2 years. RESULTS: At 2 year, TLF did not differ between O-SES vs N-BES in diabetic (9.3% vs 9.4%; RR 0.98, 95% CI 0.54-1.78) patients. The individual components of the primary endpoint did not differ among stent type. In diabetics, cardiac death occurred in 3% of O-SES-treated and in 3.8% of N-BES-treated patients (RR 0.77, 95% CI 0.29-2.08), MI occurred in 3.0% of O-SES-treated and in 3.8% of N-BES-treated patients (RR 0.76, 95% CI 0.28-2.06) and TLR occurred in 5,5% of O-SES-treated and in 6.0% of N-BES-treated patients (RR 0.91, 95% CI 0.43-1.95). CONCLUSION: TLF did not differ between O-SES- and N-BES-treated diabetic patients.

17 Article Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry. 2018

Steensig, Kamilla / Olesen, Kevin K W / Thim, Troels / Nielsen, Jens C / Jensen, Svend E / Jensen, Lisette O / Kristensen, Steen D / Bøtker, Hans Erik / Lip, Gregory Y H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. · Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Thromb Haemost · Pubmed #30419601.

ABSTRACT: BACKGROUND:  Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA OBJECTIVES:  This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. MATERIALS AND METHODS:  Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA RESULTS:  Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. CONCLUSION:  Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA

18 Article Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart Disease. 2018

Nørgaard, Bjarne L / Terkelsen, Christian J / Mathiassen, Ole N / Grove, Erik L / Bøtker, Hans Erik / Parner, Erik / Leipsic, Jonathon / Steffensen, Flemming H / Riis, Anders H / Pedersen, Kamilla / Christiansen, Evald H / Mæng, Michael / Krusell, Lars R / Kristensen, Steen D / Eftekhari, Ashkan / Jakobsen, Lars / Jensen, Jesper M. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. ·J Am Coll Cardiol · Pubmed #30153968.

ABSTRACT: BACKGROUND: Clinical outcomes following coronary computed tomography-derived fractional flow reserve (FFR OBJECTIVES: This study sought to assess real-world clinical outcomes following a diagnostic strategy including first-line coronary computed tomography angiography (CTA) with selective FFR METHODS: The study reviewed the results of 3,674 consecutive patients with stable chest pain evaluated with CTA and FFR RESULTS: FFR CONCLUSIONS: In patients with intermediate-range coronary stenosis, FFR

19 Article Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes. 2018

Escaned, Javier / Ryan, Nicola / Mejía-Rentería, Hernán / Cook, Christopher M / Dehbi, Hakim-Moulay / Alegria-Barrero, Eduardo / Alghamdi, Ali / Al-Lamee, Rasha / Altman, John / Ambrosia, Alphonse / Baptista, Sérgio B / Bertilsson, Maria / Bhindi, Ravinay / Birgander, Mats / Bojara, Waldemar / Brugaletta, Salvatore / Buller, Christopher / Calais, Fredrik / Silva, Pedro Canas / Carlsson, Jörg / Christiansen, Evald H / Danielewicz, Mikael / Di Mario, Carlo / Doh, Joon-Hyung / Erglis, Andrejs / Erlinge, David / Gerber, Robert T / Going, Olaf / Gudmundsdottir, Ingibjörg / Härle, Tobias / Hauer, Dario / Hellig, Farrel / Indolfi, Ciro / Jakobsen, Lars / Janssens, Luc / Jensen, Jens / Jeremias, Allen / Kåregren, Amra / Karlsson, Ann-Charlotte / Kharbanda, Rajesh K / Khashaba, Ahmed / Kikuta, Yuetsu / Krackhardt, Florian / Koo, Bon-Kwon / Koul, Sasha / Laine, Mika / Lehman, Sam J / Lindroos, Pontus / Malik, Iqbal S / Maeng, Michael / Matsuo, Hitoshi / Meuwissen, Martijn / Nam, Chang-Wook / Niccoli, Giampaolo / Nijjer, Sukhjinder S / Olsson, Hans / Olsson, Sven-Erik / Omerovic, Elmir / Panayi, Georgios / Petraco, Ricardo / Piek, Jan J / Ribichini, Flavo / Samady, Habib / Samuels, Bruce / Sandhall, Lennart / Sapontis, James / Sen, Sayan / Seto, Arnold H / Sezer, Murat / Sharp, Andrew S P / Shin, Eun-Seok / Singh, Jasvindar / Takashima, Hiroaki / Talwar, Suneel / Tanaka, Nobuhiro / Tang, Kare / Van Belle, Eric / van Royen, Niels / Varenhorst, Christoph / Vinhas, Hugo / Vrints, Christiaan J / Walters, Darren / Yokoi, Hiroyoshi / Fröbert, Ole / Patel, Manesh R / Serruys, Patrick / Davies, Justin E / Götberg, Matthias. ·Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain. · Hammersmith Hospital, Imperial College London, London, United Kingdom. · CRUK & UCL Cancer Trials Centre, University College London, London, United Kingdom. · Hospital Universitario de Torrejón and Universidad Francisco de Vitoria, Madrid, Spain. · King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia. · Colorado Heart and Vascular, Lakewood, Colorado. · Mesa, Arizona. · Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. · Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. · Royal North Shore Hospital, Sydney, Australia. · Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. · Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany. · Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. · St. Michaels Hospital, Toronto, Ontario, Canada. · Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden. · Hospital Santa Maria, Lisbon, Portugal. · Kalmar County Hospital, and Linnaeus University, Faculty of Health and Life Sciences, Kalmar, Sweden. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Karlstad Hospital, Karlstad, Sweden. · Royal Brompton Hospital, Imperial College London, United Kingdom, and University of Florence, Florence, Italy. · Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea. · Pauls Stradins Clinical University Hospital, Riga, Latvia. · Conquest Hospital, St. Leonards-on-Sea, United Kingdom. · Sana Klinikum Lichtenberg, Lichtenberg, Germany. · Department of Cardiology, Reykjavik University Hospital, Reykjavik, Iceland. · Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany. · Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden. · Sunninghill Hospital, Johannesburg, South Africa. · University Magna Graecia, Catanzaro, Italy. · Imelda Hospital, Bonheiden, Belgium. · Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Cardiology, Capio S:t Görans Sjukhus, Stockholm, and Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden. · Stony Brook University Medical Center, Stony Brook, New York. · Department of Internal Medicine, Västmanland Hospital Västerås, Västerås, Sweden. · Department of Cardiology, Halmstad Hospital, Halmstad, Sweden. · John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom. · Ain Shams University, Cairo, Egypt. · Fukuyama Cardiovascular Hospital, Fukuyama, Japan. · Charite Campus Virchow Klinikum, Universitaetsmedizin, Berlin, Germany. · Seoul National University Hospital, Seoul, South Korea. · Helsinki University Hospital, Helsinki, Finland. · Flinders University, Adelaide, Australia. · Department of Cardiology, St. Göran Hospital, Stockholm, Sweden. · Gifu Heart Center, Gifu, Japan. · Amphia Hospital, Breda, the Netherlands. · Keimyung University Dongsan Medical Center, Daegu, South Korea. · Catholic University of the Sacred Heart, Rome, Italy. · Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden. · Department of Cardiology, Sahlgrenska University Gothenburg, Sweden. · AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands. · University Hospital Verona, Verona, Italy. · Emory University, Atlanta, Georgia. · Cedars-Sinai Heart Institute, Los Angeles, California. · MonashHeart and Monash University, Melbourne, Australia. · Veterans Affairs Long Beach Healthcare System, Long Beach, California. · Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. · Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom. · Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. · Washington University School of Medicine, St. Louis, Missouri. · Aichi Medical University Hospital, Aichi, Japan. · Royal Bournemouth General Hospital, Bournemouth, United Kingdom. · Tokyo Medical University, Tokyo, Japan. · Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, United Kingdom. · Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France. · VU University Medical Center, Amsterdam, the Netherlands. · Department of Medical Sciences, Uppsala University, Uppsala, Sweden. · Hospital Garcia de Horta, Lisbon, Portugal. · Antwerp University Hospital, Antwerp, Belgium. · Prince Charles Hospital, Brisbane, Australia. · Fukuoka Sannou Hospital, Fukuoka, Japan. · Duke University, Durham, North Carolina. · Department of Cardiology, Imperial College London, London, United Kingdom. · Hammersmith Hospital, Imperial College London, London, United Kingdom. Electronic address: justindavies@heart123.com. ·JACC Cardiovasc Interv · Pubmed #30093050.

ABSTRACT: OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.

20 Article Randomized clinical comparison of the dual-therapy CD34 antibody-covered sirolimus-eluting Combo stent with the sirolimus-eluting Orsiro stent in patients treated with percutaneous coronary intervention: Rationale and study design of the Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) X trial. 2018

Jakobsen, Lars / Christiansen, Evald H / Maeng, Michael / Kristensen, Steen D / Bøtker, Hans E / Terkelsen, Christian J / Madsen, Morten / Raungaard, Bent / Jensen, Svend E / Christensen, Martin K / Hansen, Henrik Steen / Jensen, Lisette O. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: larsj@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Am Heart J · Pubmed #29807307.

ABSTRACT: BACKGROUND: The Combo stent (OrbusNeich, Hoevelaken, the Netherlands) combining an abluminal, bioabsorbable polymer eluting sirolimus with a luminal CD34+ antibody to capture endothelial progenitor cells has been developed to further improve safety and efficacy of coronary interventions. We have designed a large-scale registry-based randomized clinical trial to compare the Combo stent to the Orsiro stent (Biotronik, Bülach, Switzerland) in patients undergoing percutaneous coronary intervention. METHODS: The SORT OUT X study will randomly assign 3,140 patients to treatment with Combo or Orsiro stents at 3 sites in Western Denmark. Patients are eligible if they are ≥18 years old, have chronic stable coronary artery disease or acute coronary syndromes, and have ≥1 coronary lesion with >50% diameter stenosis requiring treatment with a drug-eluting stent. The primary end point target lesion failure is a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 12 months. Clinically driven event detection will be derived from validated Danish registries. An event rate of 4.2% is assumed in each stent group. With a sample size of 1,570 patients in each treatment arm, a 2-group large-sample normal approximation test of proportions with a 1-sided 5% significance level will have 90% power to detect noninferiority of the Combo stent compared with the Orsiro stent with a predetermined noninferiority margin of 2.1%. CONCLUSION: The SORT OUT X trial will determine whether the dual-therapy Combo stent is noninferior to the Orsiro stent with respect to clinically driven events (ClinicalTrials.govNCT03216733).

21 Article Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). 2018

Westra, Jelmer / Tu, Shengxian / Winther, Simon / Nissen, Louise / Vestergaard, Mai-Britt / Andersen, Birgitte Krogsgaard / Holck, Emil Nielsen / Fox Maule, Camilla / Johansen, Jane Kirk / Andreasen, Lene Nyhus / Simonsen, Jo Krogsgaard / Zhang, Yimin / Kristensen, Steen Dalby / Maeng, Michael / Kaltoft, Anne / Terkelsen, Christian Juhl / Krusell, Lars Romer / Jakobsen, Lars / Reiber, Johan H C / Lassen, Jens Flensted / Bøttcher, Morten / Bøtker, Hans Erik / Christiansen, Evald Høj / Holm, Niels Ramsing. ·From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.) · Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.) · Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.) · Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.) · and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.). ·Circ Cardiovasc Imaging · Pubmed #29555835.

ABSTRACT: BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS: WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS: Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.

22 Article Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy. 2018

Nissen, L / Winther, S / Westra, J / Ejlersen, J A / Isaksen, C / Rossi, A / Holm, N R / Urbonaviciene, G / Gormsen, L C / Madsen, L H / Christiansen, E H / Maeng, M / Knudsen, L L / Frost, L / Brix, L / Bøtker, H E / Petersen, S E / Bøttcher, M. ·Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark. · Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. · Department of Nuclear Medicine, Regional Hospital West Jutland, Gl.landevej 61, 7400 Herning, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark. · William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK. · Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark. · Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #29447342.

ABSTRACT: Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim of this study was to determine the diagnostic accuracy of cardiac magnetic resonance (CMR) and myocardial perfusion scintigraphy (MPS) against ICA with fractional flow reserve (FFR) in patients suspected of CAD by CCTA. Methods and results: Included were consecutive patients (1675) referred to CCTA with symptoms of CAD and low/intermediate risk profile. Patients with suspected CAD based on CCTA were randomized 1:1 to CMR or MPS followed by ICA with FFR. Obstructive CAD was defined as FFR ≤ 0.80 or > 90% diameter stenosis by visual assessment. After initial CCTA, 392 patients (23%) were randomized; 197 to CMR and 195 to MPS. Perfusion scans and ICA were completed in 292 patients (CMR 148, MPS 144). Based on the ICA, 117/292 (40%) patients were classified with CAD. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for CMR were 41%, 95% CI [28-54], 84% [75-91], 62% [45-78], and 68% [58-76], respectively. For the MPS group 36% [24-50], 94% [87-98], 81% [61-93], and 68% [59-76], respectively. Conclusion: Patients with low/intermediate CAD risk and a positive CCTA scan represent a challenge to perfusion techniques indicated by the low sensitivity of both CMR and MPS with FFR as a reference. The mechanisms underlying this discrepancy need further investigation.

23 Article The year in cardiology 2017: coronary interventions. 2018

Kristensen, Steen Dalby / Maeng, Michael / Capodanno, Davide / Wijns, William. ·Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark. · Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy. · Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland. ·Eur Heart J · Pubmed #29300878.

ABSTRACT: -- No abstract --

24 Article Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study. 2018

Clemmensen, Tor Skibsted / Holm, Niels Ramsing / Eiskjær, Hans / Jakobsen, Lars / Berg, Katrine / Neghabat, Omeed / Løgstrup, Brian Bridal / Christiansen, Evald Høj / Dijkstra, Jouke / Terkelsen, Christian Juhl / Maeng, Michael / Poulsen, Steen Hvitfeldt. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark; Department of Cardiology, Horsens Regional Hospital, Horsens, Denmark. Electronic address: torskibstedclemmensen@gmail.com. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Division of Image Processing, Leiden University Medical Centre, Leiden, The Netherlands. ·J Heart Lung Transplant · Pubmed #29128426.

ABSTRACT: BACKGROUND: Optical coherence tomography (OCT) enables in-vivo cardiac allograft vasculopathy (CAV) microstructure characterization. Early coronary artery microstructure changes after heart transplantation (HTx) may provide valuable mechanistic information regarding CAV development. Our in this study was to describe and characterize changes in the coronary artery microstructure during the first year after HTx using serial OCT scans. METHODS: Twenty-six patients were enrolled at routine baseline coronary angiography 3 months after HTx. Coronary OCT scans were performed on all 3 major vessels at baseline and were repeated 12 months after HTx. We contoured the vessel layers for absolute and relative measurements. Lipid plaques, calcified plaques, layered fibrotic plaques (LFPs) and bright spots were analyzed by delineating circumferential borders and measuring angulation of total circumference. RESULTS: A total of 8,789 frames from 71 vessels were analyzed after 3 and 12 months (vessel length 79 ± 24 mm vs 82 ± 23 mm, respectively, p = 0.39). Mean intima area increased by 20% from 3 months to 12 months (1.6 [1.2 to 2.7] mm CONCLUSIONS: Early CAV formation during the first year after HTx is characterized by a pronounced intima layer thickening strongly associated with LFP progression. In contrast, the extent of lipid plaque and calcifications remained stable. LFP formation may be a key mechanism in CAV.

25 Article Two-year outcome after biodegradable polymer sirolimus- and biolimus-eluting coronary stents (from the randomised SORT OUT VII trial). 2018

Jensen, Lisette Okkels / Maeng, Michael / Raungaard, Bent / Hansen, Knud Nørregaard / Kahlert, Johnny / Jensen, Svend Eggert / Hansen, Henrik Steen / Lassen, Jens Flensted / Bøtker, Hans Erik / Christiansen, Evald Høj. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. ·EuroIntervention · Pubmed #28870882.

ABSTRACT: -- No abstract --

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