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Coronary Artery Disease: HELP
Articles by Erik Magnus Ohman
Based on 40 articles published since 2008
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Between 2008 and 2019, E. M. Ohman wrote the following 40 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial The challenges with chronic angina. 2014

Ohman, E Magnus / Alexander, Karen P. ·From the Duke Program for Advanced Coronary Disease, Division of Cardiology, Department of Medicine, and Duke Clinical Research Institute, Duke University, Durham, NC. ·N Engl J Med · Pubmed #25176137.

ABSTRACT: -- No abstract --

2 Editorial Left ventricular support systems for high-risk percutaneous coronary interventions: how can we improve outcomes for rare procedures? 2013

Vavalle, John P / Ohman, E Magnus. · ·Circulation · Pubmed #23224209.

ABSTRACT: -- No abstract --

3 Editorial Repeat revascularization after PCI: are we reinventing the wheel or redefining Achilles' heel? 2012

Alhejily, Wesam A / Ohman, E Magnus. · ·Circ Cardiovasc Interv · Pubmed #23250971.

ABSTRACT: -- No abstract --

4 Editorial When can noninferior be superior? The multidimensional nature of clinical decision-making calls for innovative approaches to clinical trials. 2010

Ohman, E Magnus / Califf, Robert M. · ·J Am Coll Cardiol · Pubmed #20152560.

ABSTRACT: -- No abstract --

5 Editorial What do you need to know before performing a percutaneous coronary intervention? 2008

Cavender, Matthew A / Ohman, E Magnus. · ·Circulation · Pubmed #18678781.

ABSTRACT: -- No abstract --

6 Review A Practical Approach to Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention: An Interventional Perspective. 2016

Atkinson, Tamara M / Ohman, E Magnus / O'Neill, William W / Rab, Tanveer / Cigarroa, Joaquin E / Anonymous1150867. ·Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. · Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. · Division of Cardiology, Henry Ford Hospital, Detroit, Michigan. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. Electronic address: cigarroa@ohsu.edu. ·JACC Cardiovasc Interv · Pubmed #27151604.

ABSTRACT: Percutaneous mechanical circulatory support has been used to stabilize patients in cardiogenic shock and provide hemodynamic support during high-risk percutaneous coronary interventions for several decades. The goal of this paper is to provide a practical approach to percutaneous mechanical circulatory support in patients undergoing percutaneous coronary intervention with cardiogenic shock and/or high risk features to aid in decision making for interventional cardiologists.

7 Review CLINICAL PRACTICE. Chronic Stable Angina. 2016

Ohman, E Magnus. ·From the Program for Advanced Coronary Disease, Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, NC. ·N Engl J Med · Pubmed #27007960.

ABSTRACT: -- No abstract --

8 Review Translational platelet research in patients with coronary artery disease: what are the major knowledge gaps? 2012

Gurbel, Paul A / Roe, Matthew T / Jakubowski, Joseph A / Shah, Svathi / Erlinge, David / Goodman, Shaun G / Huber, Kurt / Chan, Mark Y / Cornel, Jan H / Tantry, Udaya S / Ohman, E Magnus. ·Sinai Center for Thrombosis Research, Cardiac Catheterization Laboratory, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA. PGURBEL@LIFEBRIDGEHEALTH.ORG ·Thromb Haemost · Pubmed #22627684.

ABSTRACT: Translational platelet function investigations performed in the percutaneous coronary intervention (PCI)-treated population receiving clopidogrel have identified high platelet reactivity to ADP (HPR) as a major risk factor for both acute as well as long-term ischaemic event occurrence, including stent thrombosis. Recent studies have highlighted the relation of single nucleotide polymorphisms of genes involved in clopidogrel absorption and metabolism to reduced pharmacokinetic and pharmacodynamic responses to clopidogrel. CYP 2C19 loss-of-function (LoF) allele carriage has been associated with increased thrombotic risk in the PCI population. However, there is no information regarding the utility of platelet function testing to predict outcomes in patients with stable coronary artery disease and in medically managed patients with acute coronary syndromes. Additionally, few studies have included longitudinal assessment of platelet function to assess a potential time-dependent relation to ischaemic event occurrence and no phase-III antiplatelet-therapy trial has included a large enough platelet function sub-study to examine the relation between on-treatment platelet reactivity, bleeding, and ischaemic event occurrence. Therefore, futher studies are needed to delineate the role of platelet function testing across the spectrum of symptomatic coronary artery disease.

9 Review Contemporary approach to the diagnosis and management of non-ST-segment elevation acute coronary syndromes. 2008

Boden, William E / Shah, Prediman K / Gupta, Vipul / Ohman, E Magnus. ·Division of Cardiology, Department of Medicine, Buffalo General Hospital and Kaleida Health, State University of New York (SUNY) at Buffalo School of Medicine and Biomedical Science, Buffalo, NY 14203, USA. ·Prog Cardiovasc Dis · Pubmed #18313479.

ABSTRACT: The management of patients with acute coronary syndromes (ACS) has evolved dramatically over the past decade and, in many respects, represents a rapidly moving target for the cardiologist and internist who seek to integrate these recent advances into contemporary clinical practice. Unstable angina and non-ST-segment elevation myocardial infarction (MI) comprise a growing percentage of patients with ACS and is emerging as a major public health problem worldwide, especially in Western countries, despite significant improvements and refinements in management over the past 20 years. Against this backdrop of a multitude of randomized, controlled clinical trials that have established the scientific foundation upon which evidence-based treatment strategies have emerged and become increasingly refined, the clinician is frequently confronted with panoply of choices that can create uncertainty or confusion regarding "optimal management". While the debate about the ideal approach to the management of non-ST-segment elevation (NSTE) ACS (i.e., routine "early invasive strategy" versus an "ischemia-guided", or "conservative", strategy) has been ongoing for over a decade, clinical trials results provide compelling evidence that intermediate- and high-risk ACS patients derived significant reductions in both morbidity and mortality with mechanical or surgical intervention, especially when revascularization is coupled with aggressive, multifaceted (anti-platelet, antithrombin, anti-ischemic and anti-atherogenic) medical therapy along with risk factor modification. For these reasons, it seems especially timely and appropriate to present a state-of-the-art paper that reviews the latest advances in the management of NSTE ACS, mindful of the fact that even this noble effort to synthesize and integrate a prodigious amount of scientific information and cardiovascular therapeutics is destined to evolve still further as our full-scale assault on optimizing clinical outcomes by harmonizing the advances in mechanical and pharmacologic interventions continues unabated.

10 Clinical Trial Evaluating the learning curve in the prospective Randomized Clinical Trial of hemodynamic support with Impella 2.5 versus Intra-Aortic Balloon Pump in patients undergoing high-risk percutaneous coronary intervention: a prespecified subanalysis of the PROTECT II study. 2014

Henriques, José P S / Ouweneel, Dagmar M / Naidu, Srihari S / Palacios, Igor F / Popma, Jeffrey / Ohman, E Magnus / O'Neill, William W. ·Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.p.henriques@amc.uva.nl. · Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. · Winthrop University Hospital, Mineola, NY. · Massachusetts General Hospital, Boston, MA. · Beth Israel Deaconess Hospital, Boston, MA. · Duke University Medical Center, Durham, NC. · Henry Ford Hospital, Detroit, MI. ·Am Heart J · Pubmed #24655695.

ABSTRACT: BACKGROUND: The introduction of new medical devices may be accompanied by a learning curve. METHODS: To evaluate the impact of the device learning curve on the outcomes of PROTECT II trial, comparing Impella 2.5 versus the intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention, we report on a prespecified analysis, excluding the first Impella 2.5 and IABP patients at each site. RESULTS: A total of 448 patients were enrolled at 74 sites. Among these, 58 patients were the first to receive Impella 2.5 at their site, 62 were the first to receive IABP. A trend toward higher major adverse events (MAEs) at 30 days was observed for the subgroup of first versus remaining Impella 2.5 patients: 44.8% versus 31.7%, P = .072. MAE rates for the first and remaining IABP patients were similar at 30 days. After exclusion of the first patient in each group, MAE rates for Impella 2.5 and IABP were 31.7% versus 40.0% (P = .119) at 30 days and 38.0% versus 50.0% (P = .029) at 90 days. CONCLUSIONS: Significantly lower 90-day MAE rates were observed with the use of Impella 2.5 compared to the use of IABP after excluding the first patient per group at each site. This prespecified analysis suggests a learning curve associated with initial introduction of the Impella 2.5. Clinical trials should better address the training aspect of new devices, especially when compared with more established devices.

11 Clinical Trial Influence of crossover on mortality in a randomized study of revascularization in patients with systolic heart failure and coronary artery disease. 2013

Doenst, Torsten / Cleland, John G F / Rouleau, Jean L / She, Lilin / Wos, Stanislaw / Ohman, E Magnus / Krzeminska-Pakula, Maria / Airan, Balram / Jones, Robert H / Siepe, Matthias / Sopko, George / Velazquez, Eric J / Racine, Normand / Gullestad, Lars / Filgueira, Jose Luis / Lee, Kerry L / Anonymous3920753. ·Department of Cardiothoracic Surgery, University of Jena, Jena, Germany. doenst@med.uni-jena.de ·Circ Heart Fail · Pubmed #23515275.

ABSTRACT: BACKGROUND: To assess the influence of therapy crossovers on treatment comparisons and mortality at 5 years in patients with ischemic heart disease and heart failure randomly assigned to medical therapy alone (MED) or to MED and coronary artery bypass graft (CABG) surgery in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. METHODS AND RESULTS: The influence of early crossover (within the first year after randomization) on 5-year mortality was assessed using time-dependent multivariable Cox models. CABG was performed in 65/602 patients (10.8%) assigned to MED, and 55/610 patients (9.0%) assigned to CABG received MED only. Common reasons for crossover from MED to CABG were progressive symptoms or acute decompensation. MED-assigned patients who underwent CABG had lower 5-year mortality than those who received MED only (25% vs 42%; hazard ratio, 0.50; 95% confidence interval, 0.30-0.85; P=0.008).The main reason for crossover from CABG to MED was patient/family decision. Five patients did not undergo their assigned CABG within a year but died before receiving surgery without status change. They were deemed crossover to MED. The CABG-to-MED crossover population had higher 5-year mortality compared with those treated with CABG per-protocol (59% vs 33%; hazard ratio, 2.01; 95% confidence interval, 1.36-2.96; P<0.001). CABG was associated with lower mortality compared with MED in per-protocol and several time-dependent analyses (all P<0.05). CONCLUSIONS: CABG reduced mortality in both the per-protocol and crossover STICH patient populations. Crossover from assigned therapy, therefore, diminished the impact of CABG on survival in STICH when analyzed by intention to treat. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.

12 Article Predicting risk of cardiac events among ST-segment elevation myocardial infarction patients with conservatively managed non-infarct-related artery coronary artery disease: An analysis of the Duke Databank for Cardiovascular Disease. 2017

Hirji, Sameer A / Stevens, Susanna R / Shaw, Linda K / Campbell, Erin C / Granger, Christopher B / Patel, Manesh R / Sketch, Michael H / Wang, Tracy Y / Ohman, E Magnus / Peterson, Eric D / Brennan, J Matthew. ·Duke Clinical Research Institute, Duke University Health System, Durham, NC, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Duke Clinical Research Institute, Duke University Health System, Durham, NC, USA. · Duke Clinical Research Institute, Duke University Health System, Durham, NC, USA. Electronic address: j.matthew.brennan@dm.duke.edu. ·Am Heart J · Pubmed #29223429.

ABSTRACT: BACKGROUND: Recent randomized evidence has demonstrated benefit with complete revascularization during the index hospitalization for multivessel coronary artery disease ST-segment elevation myocardial infarction (STEMI) patients; however, this benefit likely depends on the risk of future major adverse cardiovascular events (MACE). METHODS: Using data from Duke University Medical Center (2003-2012), we identified those at high risk for 1-year MACE among 664 STEMI patients with conservatively managed non-infarct-related artery (non-IRA) lesions. Using multivariable logistic regression, we identified clinical and angiographic characteristics associated with MACE (death, myocardial infarction, urgent revascularization) to 1 year and developed an integer-based risk prediction model for clinical use. RESULTS: In this cohort (median age 60 years, 30% female), the unadjusted Kaplan-Meier rates for MACE at 30 days and 1 year were 10% and 28%, respectively. Characteristics associated with MACE at 1 year included reduced left ventricular ejection fraction, hypertension, heart failure, higher-risk non-IRA vessels (left main), renal insufficiency, and greater % stenosis of non-IRA lesions. A 15-point risk score including these variables had modest discrimination (C-index 0.67) across a spectrum of subsequent risk (4%-88%) for 1-year MACE. CONCLUSIONS: There is a wide spectrum of risk following primary percutaneous coronary intervention for STEMI patients with multivessel disease. Using readily available clinical characteristics, the expected incidence of MACE by 1 year can be calculated with a simplified risk score, facilitating a tailored approach to clinical care.

13 Article Potent P2Y 2017

Lau, Emily S / Braunwald, Eugene / Murphy, Sabina A / Wiviott, Stephen D / Bonaca, Marc P / Husted, Steen / James, Stefan K / Wallentin, Lars / Clemmensen, Peter / Roe, Matthew T / Ohman, E Magnus / Harrington, Robert A / Mega, Jessica L / Bhatt, Deepak L / Sabatine, Marc S / O'Donoghue, Michelle L. ·Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Cardiology, Århus University Hospital, Århus, Denmark. · Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. · Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany; Department of Medicine, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark. · Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina. · Department of Medicine, Stanford University, Stanford, California. · Verily Life Sciences, Mountain View, California. · TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: modonoghue@partners.org. ·J Am Coll Cardiol · Pubmed #28335837.

ABSTRACT: BACKGROUND: Sex-specific differences in response to antiplatelet therapies have been described. Whether women and men derive comparable benefit from intensification of antiplatelet therapy remains uncertain. OBJECTIVES: The study investigated the efficacy and safety of the potent P2Y METHODS: A collaborative sex-specific meta-analysis was conducted of phase III or IV randomized trials of potent P2Y RESULTS: Potent P2Y CONCLUSIONS: In randomized trials, the efficacy and safety of the potent P2Y

14 Article Revascularization Strategies and Outcomes in Elderly Patients With Multivessel Coronary Disease. 2017

Posenau, J Trevor / Wojdyla, Daniel M / Shaw, Linda K / Alexander, Karen P / Ohman, E Magnus / Patel, Manesh R / Smith, Peter K / Rao, Sunil V. ·Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. Electronic address: j.posenau@wustl.edu. · Duke Clinical Research Institute, Durham, North Carolina. · Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. ·Ann Thorac Surg · Pubmed #28109574.

ABSTRACT: BACKGROUND: Balancing risks and benefits of revascularization in elderly patients with multivessel coronary artery disease (CAD) is challenging. The appropriate revascularization strategy for elderly patients with multivessel CAD is unclear. METHODS: We used the Duke Databank for Cardiovascular Disease to identify patients aged 75 years or more who had multivessel disease and treatment with percutaneous coronary intervention or coronary artery bypass graft surgery (CABG) within 30 days of the index catheterization between October 1, 2003, and June 30, 2013. The primary outcome was a composite of all-cause death, myocardial infarction, and coronary revascularization through latest follow-up. Associations between bare-metal stents (BMS), drug-eluting stents (DES), CABG, and outcomes were determined using multivariable Cox proportional hazards modeling, adjusting for potential confounders with CABG as the reference. Comparisons between BMS and DES were done using BMS as the reference. RESULTS: We identified 763 patients who met the criteria (BMS, n = 202; DES, n = 411; CABG, n = 150). The median age was 79 years (interquartile range, 76 to 82), and the median follow-up was 6.28 years. After adjustment, both BMS and DES were associated with a higher risk of the primary outcome. The BMS versus CABG hazard ratio was 1.58 (95% confidence interval: 1.15 to 2.19, p = 0.01). The DES versus CABG hazard ratio was 1.45 (95% confidence interval: 1.08 to 1.95, p = 0.01). The adjusted hazard ratio for DES versus BMS (0.92, 95% confidence interval: 0.71 to 1.19, p = 0.51) was not statistically significant. CONCLUSIONS: In this single-center analysis of 763 elderly patients with multivessel disease, CABG was associated with the best overall clinical outcomes, but was selected for a minority of patients. An adequately powered, randomized trial should be considered to define the best treatment strategy for this population.

15 Article Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. 2016

Eisen, Alon / Bhatt, Deepak L / Steg, P Gabriel / Eagle, Kim A / Goto, Shinya / Guo, Jianping / Smith, Sidney C / Ohman, E Magnus / Scirica, Benjamin M / Anonymous24340882. ·Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA. · Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom. · University of Michigan Health System, Ann Arbor, MI. · Department of Medicine, Tokai University School of Medicine, Isehara, Japan. · Heart and Vascular Center, University of North Carolina at Chapel Hill, NC. · Duke University Medical Center, Durham, NC. · Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA bscirica@partners.org. ·J Am Heart Assoc · Pubmed #27680665.

ABSTRACT: BACKGROUND: The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated. METHODS AND RESULTS: Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end-point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11-1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99-1.14, P=0.11), and total primary end-point events (adjusted risk ratio 1.08, CI 1.01-1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06-1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21-1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13-1.34, P<0.001). CONCLUSIONS: Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

16 Article Impact of Non-Infarct-Related Artery Disease on Infarct Size and Outcomes (from the CRISP-AMI Trial). 2016

Shah, Rohan / Clare, Robert M / Chiswell, Karen / Jones, W Schuyler / Kumar, A Sreenivas / Thiele, Holger / Smalling, Richard W / Chandra, Praveen / Cohen, Marc / Perera, Divaka / Chew, Derek P / French, John K / Blaxill, Jonathan / Ohman, E Magnus / Patel, Manesh R. ·Duke Clinical Research Institute, Durham, NC. · Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC. · Department of Cardiovascular Sciences, Citizens Hospitals, Hyderabad, India. · Medical Clinic II, University Heart Center Lübeck, Germany. · Division of Cardiology, Memorial Hermann Heart and Vascular Institute, University of Texas, Houston. · Division of Cardiology, Medanta - the Medicity, Haryana, India. · Division of Cardiology, Newark Beth Israel Medical Center, NJ. · Cardiovascular Division, King's College, London, England. · Department of Cardiovascular Medicine, Flinders Medical Center, Bedford Park, Australia. · Department of Cardiology, Liverpool Hospital, Australia. · Department of Cardiology, Leeds General Infirmary, England. · Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: manesh.patel@duke.edu. ·Am J Med · Pubmed #27542611.

ABSTRACT: BACKGROUND: Non-infarct-related artery (non-IRA) disease is prevalent in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the impact of non-IRA disease on infarct size and clinical outcomes in patients with acute STEMI. METHODS: The Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial randomized patients to intra-aortic balloon counterpulsation (IABC) vs no IABC prior to percutaneous coronary intervention in patients with acute STEMI. Infarct size (% left ventricular mass) at 3-5 days post percutaneous coronary intervention and 6-month clinical outcomes were compared between patients with and without non-IRA disease (defined as ≥50% stenosis in at least one non-IRA). RESULTS: A total of 324 (96.1%) patients had anterior STEMI, of whom 34.9% had non-IRA disease. There was no difference in infarct size (% left ventricular mass) between patients with and without non-IRA disease (median 39% vs 39%; P = .73). At 6 months, there was no difference in rates of recurrent myocardial infarction (0.9% vs 0.9%; P = .78), major Thrombolysis In Myocardial Infarction bleeding (0.9% vs 0.5%; P = .77), or all-cause death (3.5% vs 2.4%; P = .61) in patients with and without non-IRA disease, respectively. Patients with non-IRA disease had a higher rate of new/worsening heart failure with hospitalization (8.8% vs 1.9%; P = .0050). CONCLUSIONS: More than one-third of patients with anterior STEMI in the CRISP-AMI study had non-IRA disease. These patients had similar infarct sizes and rates of recurrent myocardial infarction, major bleeding, and all-cause death. Patients with non-IRA disease did have a higher rate of new/worsening heart failure with hospitalization. Further study is needed to understand the mechanisms of outcomes of patients with non-IRA disease.

17 Article Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial. 2016

Weisz, Giora / Généreux, Philippe / Iñiguez, Andres / Zurakowski, Aleksander / Shechter, Michael / Alexander, Karen P / Dressler, Ovidiu / Osmukhina, Anna / James, Stefan / Ohman, E Magnus / Ben-Yehuda, Ori / Farzaneh-Far, Ramin / Stone, Gregg W / Anonymous7500845. ·Shaare Zedek Medical Center, Jerusalem, Israel; New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA. Electronic address: weiszg@szmc.org.il. · Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montreal, Université de Montreal, Montreal, QC, Canada. · Hospital de Meixoeiro, Vigo, Spain. · American Heart of Poland SA, Katowice, Poland. · Chaim Sheba Medical Center, Tel Hashomer, Israel. · Duke Clinical Research Institute and Duke University, Durham, NC, USA. · Cardiovascular Research Foundation, New York, NY, USA. · Gilead Sciences, Foster City, CA, USA. · Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. · New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA. ·Lancet · Pubmed #26474810.

ABSTRACT: BACKGROUND: Incomplete revascularisation is common after percutaneous coronary intervention and is associated with increased mortality and adverse cardiovascular events. We aimed to assess whether adjunctive anti-ischaemic pharmacotherapy with ranolazine would improve the prognosis of patients with incomplete revascularisation after percutaneous coronary intervention. METHODS: We performed this multicentre, randomised, parallel-group, double-blind, placebo-controlled, event-driven trial at 245 centres in 15 countries in Europe, Israel, Russia, and the USA. Patients (aged ≥18 years) with a history of chronic angina with incomplete revascularisation after percutaneous coronary intervention (defined as one or more lesions with ≥50% diameter stenosis in a coronary artery ≥2 mm diameter) were randomly assigned (1:1), via an interactive web-based block randomisation system (block sizes of ten), to receive either twice-daily oral ranolazine 1000 mg or matching placebo. Randomisation was stratified by diabetes history (presence vs absence) and acute coronary syndrome presentation (acute coronary syndrome vs non-acute coronary syndrome). Study investigators, including all research teams, and patients were masked to treatment allocation. The primary endpoint was time to first occurrence of ischaemia-driven revascularisation or ischaemia-driven hospitalisation without revascularisation. Analysis was by intention to treat. This study is registered at ClinicalTrials.gov, number NCT01442038. FINDINGS: Between Nov 3, 2011, and May 27, 2013, we randomly assigned 2651 patients to receive ranolazine (n=1332) or placebo (n=1319); 2604 (98%) patients comprised the full analysis set. After a median follow-up of 643 days (IQR 575-758), the composite primary endpoint occurred in 345 (26%) patients assigned to ranolazine and 364 (28%) patients assigned to placebo (hazard ratio 0·95, 95% CI 0·82-1·10; p=0·48). Incidence of ischaemia-driven revascularisation and ischaemia-driven hospitalisation did not differ significantly between groups. 189 (14%) patients in the ranolazine group and 137 (11%) patients in the placebo group discontinued study drug because of an adverse event (p=0·04). INTERPRETATION: Ranolazine did not reduce the composite rate of ischaemia-driven revascularisation or hospitalisation without revascularisation in patients with a history of chronic angina who had incomplete revascularisation after percutaneous coronary intervention. Further studies are warranted to establish whether other treatment could be effective in improving the prognosis of high-risk patients in this population. FUNDING: Gilead Sciences, Menarini.

18 Article Percutaneous left ventricular assist device for high-risk percutaneous coronary interventions: Real-world versus clinical trial experience. 2015

Cohen, Mauricio G / Matthews, Ray / Maini, Brij / Dixon, Simon / Vetrovec, George / Wohns, David / Palacios, Igor / Popma, Jeffrey / Ohman, E Magnus / Schreiber, Theodore / O'Neill, William W. ·University of Miami Hospital, Miami, FL. Electronic address: mgcohen@med.miami.edu. · Keck School of Medicine, University of Southern California, Los Angeles, CA. · Pinnacle Health System, Harrisburg, PA. · William Beaumont University Hospital, Royal Oak, MI. · Pauley Heart Center, Virginia Commonwealth University, Richmond, VA. · Spectrum Health, Grand Rapids, MI. · Massachusetts General Hospital, Boston, MA. · Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Duke Clinical Research Institute, Durham, NC. · Harper University Hospital, Detroit, MI. · Henry Ford Hospital, Detroit, MI. ·Am Heart J · Pubmed #26542494.

ABSTRACT: BACKGROUND: High-risk percutaneous coronary intervention (PCI) supported by percutaneous left ventricular assist devices offers a treatment option for patients with severe symptoms, complex and extensive coronary artery disease, and multiple comorbidities. The extrapolation from clinical trial to real-world practice has inherent uncertainties. We compared the characteristics, procedures, and outcomes of high-risk PCI supported by a microaxial pump (Impella 2.5) in a multicenter registry versus the randomized PROTECT II trial (NCT00562016). METHODS: The USpella registry is an observational multicenter voluntary registry of Impella technology. A total of 637 patients treated between June 2007 and September 2013 were included. Of them, 339 patients would have met enrollment criteria for the PROTECT II trial. These were compared with 216 patients treated in the Impella arm of PROTECT II. RESULTS: Compared to the clinical trial, registry patients were older (70 ± 11.5 vs 67.5 ± 11.0 years); more likely to have chronic kidney disease (30% vs 22.7%), prior myocardial infarction (69.3% vs 56.5%), or prior bypass surgery (39.4% vs. 30.2%); and had similar prevalence of diabetes, peripheral vascular disease, and prior stroke. Registry patients had more extensive coronary artery disease (2.2 vs 1.8 diseased vessels) and had a similar Society of Thoracic Surgeons predicted risk of mortality. At hospital discharge, registry patients experienced a similar reduction in New York Heart Association class III to IV symptoms compared to trial patients. Registry patients had a trend toward lower in-hospital mortality (2.7% vs 4.6, P = .27). CONCLUSIONS: USpella provides a real-world and contemporary estimation of the type of procedures and outcomes of high-risk patients undergoing PCI supported by Impella 2.5. Despite the higher risk of registry patients, clinical outcomes appeared to be favorable and consistent compared with the randomized trial.

19 Article Performance of currently available risk models in a cohort of mechanically supported high-risk percutaneous coronary intervention--From the PROTECT II randomized trial. 2015

Henriques, José P S / Claessen, Bimmer E / Dangas, George D / Kirtane, Ajay J / Popma, Jeffrey J / Massaro, Joseph M / Cohen, Barry M / Ohman, E Magnus / Moses, Jeffrey W / O'Neill, William W. ·Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.p.henriques@amc.uva.nl. · Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · Mount Sinai Medical Center, New York, NY, United States. · Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, United States. · Beth Israel Deaconess Medical Center, Boston, Ma, United States. · Boston University, Boston, Ma, United States. · Morristown Medical Center, Morristown, NJ, United States. · Duke University Medical Center, United States. · Henry Ford Hospital, Detroid, Mi, United States. ·Int J Cardiol · Pubmed #25909982.

ABSTRACT: BACKGROUND: Procedural risk scores facilitate clinical decision making by using individual patient characteristics to estimate the risk of adverse events. The performance of PCI-based risk scores is not well-described among patients undergoing hemodynamically supported high risk PCI. METHODS AND RESULTS: A total of 427 patients with unprotected left main disease, last remaining vessel or three-vessel disease with severely reduced left ventricular function underwent supported high-risk PCI with an intra-aortic balloon pump (IABP, N = 211) or a left ventricular assist device (Impella 2.5, N = 216) as part of the PROTECT II trial. We examined the performance of the additive Euroscore, logistic Euroscore, STS mortality score, STS morbidity and mortality score, Mayo Clinic risk score and New York state PCI risk score on the endpoint of 90-day mortality in this unique high-risk population. Mean age was 67.2 ± 10.9 years; 65.8% of patients were in NYHA class III/IV, and mean LVEF was 24%. All-cause 90-day mortality was 10.4%. The scores were generally correlated (p < 0.0001 for all comparisons), with R(2) values ranging from 0.28 (STS morbidity/mortality and Mayo Clinic) to 0.68 (logistic Euroscore and STS mortality). However, receiver-operator curves for 90-day all-cause mortality for all risk scores demonstrated poor discriminatory performance with c-statistics of 0.542-0.616. Calibration of the risk scores was not poor, but varied according to the specific score examined. CONCLUSION: The discriminatory capacity of currently available risk models is suboptimal when applied to a cohort of mechanically supported complex high-risk PCI. A risk score designed specifically for this population could help to further refine risk assessment.

20 Article Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. 2014

Park, Duk-Woo / Clare, Robert M / Schulte, Phillip J / Pieper, Karen S / Shaw, Linda K / Califf, Robert M / Ohman, E Magnus / Van de Werf, Frans / Hirji, Sameer / Harrington, Robert A / Armstrong, Paul W / Granger, Christopher B / Jeong, Myung-Ho / Patel, Manesh R. ·Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea2Duke Clinical Research Institute, Durham, North Carolina. · Duke Clinical Research Institute, Durham, North Carolina. · Duke Translational Medical Institute, Durham, North Carolina. · University Hospitals, Leuven, Belgium. · Stanford University, Stanford, California. · University of Alberta, Edmonton, Canada. · Chonnam National University, Gwangju, Korea. ·JAMA · Pubmed #25399277.

ABSTRACT: IMPORTANCE: Little information exists about the anatomical characteristics and clinical relevance of non-infarct-related artery (IRA) disease among patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: To investigate the incidence, extent, and location of obstructive non-IRA disease and compare 30-day mortality according to the presence of non-IRA disease in patients with STEMI. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of patients pooled from a convenience sample of 8 independent, international, randomized STEMI clinical trials published between 1993 and 2007. Follow-up varied from 1 month to 1 year. Among 68,765 patients enrolled in the trials, 28,282 patients with valid angiographic information were included in this analysis. Obstructive coronary artery disease was defined as stenosis of 50% or more of the diameter of a major epicardial artery. To assess the generalizability of trial-based results, external validation was performed using observational data for patients with STEMI from the Korea Acute Myocardial Infarction Registry (KAMIR) (between November 1, 2005, and December 31, 2013; n = 18,217) and the Duke Cardiovascular Databank (between January 1, 2005, and December 31, 2012; n = 1812). MAIN OUTCOMES AND MEASURES: Thirty-day mortality following STEMI. RESULTS: Overall, 52.8% (14,929 patients) had obstructive non-IRA disease; 29.6% involved 1 vessel and 18.8% involved 2 vessels. There was no substantial difference in the extent and distribution of non-IRA disease according to the IRA territory. Unadjusted and adjusted rates of 30-day mortality were significantly higher in patients with non-IRA disease than in those without non-IRA disease (unadjusted, 4.3% vs 1.7%, respectively; risk difference, 2.7% [95% CI, 2.3% to 3.0%], P < .001; and adjusted, 3.3% vs 1.9%, respectively; risk difference, 1.4% [95% CI, 1.0% to 1.8%], P < .001). The overall prevalence and association of non-IRA disease with 30-day mortality was consistent with findings from the KAMIR registry (adjusted, 3.6% for patients with non-IRA disease vs 2.5% in those without it; risk difference, 1.1% [95% CI, 0.6% to 1.7%]; P < .001), but not with the Duke database (adjusted, 4.7% with non-IRA disease vs 4.3% without it; risk difference, 0.4% [95% CI, -1.4% to 2.2%], P = .65). CONCLUSIONS AND RELEVANCE: In a retrospective pooled analysis of 8 clinical trials, obstructive non-IRA disease was common among patients presenting with STEMI, and was associated with a modest statistically significant increase in 30-day mortality. These findings require confirmation in prospectively designed studies, but raise questions about the appropriateness and timing of non-IRA revascularization in patients with STEMI.

21 Article Prognostic value of angiographic lesion complexity in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the acute catheterization and urgent intervention triage strategy trial). 2014

Goto, Kenji / Lansky, Alexandra J / Ng, Vivian G / Pietras, Cody / Nargileci, Erol / Mehran, Roxana / Parise, Helen / Feit, Frederick / Ohman, E Magnus / White, Harvey D / Bertrand, Michel E / Desmet, Walter / Hamon, Martial / Stone, Gregg W. ·Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. · Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: alexandra.lansky@yale.edu. · Division of Cardiology, Columbia University Medical Center, New York, New York; Division of Cardiology, Cardiovascular Research Foundation, New York, New York. · Division of Cardiology, New York University School of Medicine, New York, New York. · Department of Medicine - Cardiology, Duke University School of Medicine, Durham, North Carolina. · Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. · Hôpital Cardiologique, Lille, France. · Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. · Department of Cardiology, University of Caen, Normandy, France. ·Am J Cardiol · Pubmed #25312637.

ABSTRACT: Although lesion complexity is predictive of outcomes after balloon angioplasty, it is unclear whether complex lesions continue to portend a worse prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with contemporary interventional therapies. We sought to assess the impact of angiographic lesion complexity, defined by the modified American College of Cardiology/American Heart Association classification, on clinical outcomes after PCI in patients with ACS and to determine whether an interaction exists between lesion complexity and antithrombin regimen outcomes after PCI. Among the 3,661 patients who underwent PCI in the Acute Catheterization and Urgent Intervention Triage strategy study, patients with type C lesions (n = 1,654 [45%]) had higher 30-day rates of mortality (1.2% vs 0.6%, p = 0.049), myocardial infarction (9.2% vs 6.3%, p = 0.0006), and unplanned revascularization (4.3% vs 3.1%, p = 0.04) compared with those without type C lesions. In multivariate analysis, type C lesions were independently associated with myocardial infarction (odds ratio [95% confidence interval] = 1.37 [1.04 to 1.80], p = 0.02) and composite ischemia (odds ratio [95% confidence interval] = 1.49 [1.17 to 1.88], p = 0.001) at 30 days. Bivalirudin monotherapy compared with heparin plus a glycoprotein IIb/IIIa inhibitor reduced major bleeding complications with similar rates of composite ischemic events, regardless of the presence of type C lesions. There were no interactions between antithrombotic regimens and lesion complexity in terms of composite ischemia and major bleeding (p [interaction] = 0.91 and 0.80, respectively). In conclusion, patients with ACS with type C lesion characteristics undergoing PCI have an adverse short-term prognosis. Treatment with bivalirudin monotherapy reduces major hemorrhagic complications irrespective of lesion complexity with comparable suppression of adverse ischemic events as heparin plus glycoprotein IIb/IIIa inhibitor.

22 Article Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study). 2014

Pershad, Ashish / Fraij, Ghassan / Massaro, Joseph M / David, Shukri W / Kleiman, Neal S / Denktas, Ali E / Wilson, B Hadley / Dixon, Simon R / Ohman, E Magnus / Douglas, Pamela S / Moses, Jeffrey W / O'Neill, William W. ·Cavanagh Heart Center, Banner Good Samaritan Medical Center, Phoenix, Arizona. Electronic address: ashish.pershad@bannerhealth.com. · Cavanagh Heart Center, Banner Good Samaritan Medical Center, Phoenix, Arizona. · Harvard Clinical Research Institute, Boston, Massachusetts. · Providence Hospital and Medical Center, Southfield, Michigan. · Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas. · University of Texas Memorial Hermann Health Science Center, Houston, Texas. · Carolina Medical Center, Charlotte, North Carolina. · Beaumont Hospital, Royal Oak, Michigan. · Duke University Medical Center, Durham, North Carolina. · Duke Clinical Research Institute, Durham, North Carolina. · Columbia University Medical Center New York Presbyterian Hospital, New York, New York. · Henry Ford Medical Center, Detroit, Michigan. ·Am J Cardiol · Pubmed #25037676.

ABSTRACT: The outcomes of hemodynamic support during high-risk percutaneous coronary intervention in the very elderly are unknown. We sought to compare outcomes between the patients ≥80 years versus patients <80 years enrolled in the PROTECT II (Prospective Randomized Clinical Trial of Hemodynamic Support with the Impella 2.5 versus Intra-Aortic Balloon Pump in Patients undergoing High Risk Percutaneous Coronary Intervention) randomized trial. Patients who underwent high-risk percutaneous coronary intervention with an unprotected left main or last patent conduit and a left ventricular ejection fraction ≤35% or with 3-vessel disease and a left ventricular ejection fraction ≤30% were randomized to receive an intra-aortic balloon pump or the Impella 2.5; 90-day (or the longest follow-up) outcomes were compared between patients ≥80 years (n = 59) and patients <80 years (n = 368). At 90 days, the composite end point of major adverse events and major adverse cerebral and cardiac events were similar between patients ≥80 and <80 years (45.6% vs 44.1%, p = 0.823, and 23.7% vs 26.8%, p = 0.622, respectively). There were no differences in death, stroke, or myocardial infarction rates between the 2 groups, but fewer repeat revascularization procedures were required in patients ≥80 years (1.7% vs 10.4%, p = 0.032). Bleeding and vascular complication rates were low and comparable between the 2 age groups (3.4% vs 2.4%, p = 0.671, and 6.8% vs 5.4%, p = 0.677, respectively). Multivariate analysis confirmed that age was not an independent predictor of major adverse events (odds ratio = 1.031, 95% confidence interval 0.459-2.315, p = 0.941), whereas Impella 2.5 was an independent predictor for improved outcomes irrespective of age (odds ratio = 0.601, 95% confidence interval 0.391-0.923, p = 0.020). In conclusion, the use of percutaneous circulatory support is reasonable and feasible in a selected octogenarian population with similar outcomes as those of younger selected patients. Irrespective of age, the use of Impella 2.5 was an independent predictor of favorable outcomes.

23 Article Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. 2014

Planer, David / Mehran, Roxana / Ohman, E Magnus / White, Harvey D / Newman, Jonathan D / Xu, Ke / Stone, Gregg W. ·From the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.) · Icahn School of Medicine at Mount Sinai, New York, NY (R.M.) · Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.) · Duke University Medical Center, Durham, NC (E.M.O.) · Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.) · and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.). ·Circ Cardiovasc Interv · Pubmed #24847016.

ABSTRACT: BACKGROUND: Troponin elevation is a risk factor for mortality in patients with non-ST-segment-elevation acute coronary syndromes. However, the prognosis of patients with troponin elevation and nonobstructive coronary artery disease (CAD) is unknown. Our objective was therefore to evaluate the impact of nonobstructive CAD in patients with non-ST-segment-elevation acute coronary syndromes and troponin elevation enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. METHODS AND RESULTS: In the ACUITY trial, 3-vessel quantitative coronary angiography was performed in a formal substudy of 6921 patients presenting with non-ST-segment-elevation acute coronary syndromes. Patients with elevated admission troponin levels were stratified by the presence or absence of obstructive CAD (any lesion with quantitative diameter stenosis >50%). Propensity score matching was performed to adjust for baseline characteristics. Of 2442 patients with elevated troponin, 197 (8.8%) had nonobstructive CAD. Maximum diameter stenosis was 87.4 (73.2, 100.0) versus 22.6 (19.2, 25.7; P<0.0001) in patients with versus without obstructive CAD, respectively. Propensity matching yielded 117 patients with nonobstructive CAD and 331 patients with obstructive CAD, with no significant baseline differences between groups. In the matched cohort, overall 1-year mortality was significantly higher in patients with nonobstructive CAD (5.2% versus 1.6%; hazard ratio [95% confidence interval]=3.44 [1.05, 11.28]; P=0.04), driven by greater noncardiac mortality. Conversely, recurrent myocardial infarction and unplanned revascularization rates were significantly higher in patients with obstructive CAD. CONCLUSIONS: Patients with non-ST-segment-elevation acute coronary syndromes and elevated troponin levels but without obstructive CAD, while having low rates of subsequent myocardial infarction and unplanned revascularization, are still at considerable risk for 1-year mortality from noncardiac causes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.

24 Article Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. 2014

Kumbhani, Dharam J / Steg, Ph Gabriel / Cannon, Christopher P / Eagle, Kim A / Smith, Sidney C / Goto, Shinya / Ohman, E Magnus / Elbez, Yedid / Sritara, Piyamitr / Baumgartner, Iris / Banerjee, Subhash / Creager, Mark A / Bhatt, Deepak L / Anonymous4800786. ·Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA dharam@post.harvard.edu. · Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA. · University of Michigan Cardiovascular Center, Ann Arbor, MI, USA. · Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. · Department of Medicine, Tokai University School of Medicine, Isehara, Japan. · Division of Cardiology, Duke University, Durham, NC, USA. · Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. · Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland. · Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA. ·Eur Heart J · Pubmed #24585266.

ABSTRACT: AIMS: Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. METHODS: Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. RESULTS: A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01). CONCLUSION: Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.

25 Article A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease. 2013

Ducrocq, Gregory / Amarenco, Pierre / Labreuche, Julien / Alberts, Mark J / Mas, Jean-Louis / Ohman, E Magnus / Goto, Shinya / Lavallée, Philippa / Bhatt, Deepak L / Steg, Ph Gabriel. ·INSERM U 698 and Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. ·Circulation · Pubmed #23277306.

ABSTRACT: BACKGROUND: Randomized trials of antithrombotics in coronary artery disease have identified previous stroke/transient ischemic attack (TIA) as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with coronary artery disease. METHODS AND RESULTS: From the international REduction of Atherothrombosis for Continued Health (REACH) registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26,389 patients with coronary artery disease, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with previous stroke/TIA had a higher rate of recurrent cardiovascular events (cardiovascular death, myocardial infarction, or stroke) than patients without (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.40-1.65; P<0.001) and specifically of nonfatal ischemic stroke (adjusted HR, 3.06; 95% CI, 2.62-3.57; P<0.001) and nonfatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00-3.08; P=0.05). Excess risk for nonfatal hemorrhagic stroke appeared confined to the 1st year after a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51-6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR, 5.21; 95% CI, 1.24-21.90). CONCLUSIONS: In patients with coronary artery disease, a history of stroke/TIA is associated with an independent increase in risk of death, myocardial infarction, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the 1st year after stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients.

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