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Coronary Artery Disease: HELP
Articles by Expedito E. Ribeiro
Based on 14 articles published since 2008
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Between 2008 and 2019, Expedito Ribeiro wrote the following 14 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Real-world use of drug-eluting stents: the importance of registries. 2010

Ribeiro, Expedito E / Ribeiro, Henrique Barbosa. ·Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. expribeiro@terra.com.br ·Arq Bras Cardiol · Pubmed #20694400.

ABSTRACT: Over the last decades the efficacy and safety of bare metal (BMS) and drug eluting stents (DES) have been demonstrated in many different clinical scenarios, leading to their use in more than 75% of the procedures worldwide. Compared to BMS, DES have shown lower rates of angiographic restenosis and target-vessel revascularization. This benefit was initially demonstrated in trials that excluded patients with more complex lesions, such as those with larger or smaller vessels, chronic total occlusions, bifurcation lesions, stent restenosis, long lesions and left main coronary artery disease. This real-world population has been recently evaluated in many registries and meta-analyses that are reviewed herein.

2 Clinical Trial Intravascular imaging comparison of two metallic limus-eluting stents abluminally coated with biodegradable polymers: IVUS and OCT results of the DESTINY trial. 2017

Costa, J Ribamar / Chamié, Daniel / Abizaid, Alexandre A C / Ribeiro, Expedito / Meireles, George C / Prudente, Maurício / Campos, Carlos A / Castro, Juliana P / Costa, Ricardo / Lemos, Pedro A. ·Department of Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese 500, Ibirapuera, São Paulo, SP, 04012, Brazil. rmvcosta@uol.com.br. · Department of Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese 500, Ibirapuera, São Paulo, SP, 04012, Brazil. · Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil. · Hospital do Servidor Público Estadual-IAMSPE, São Paulo, SP, Brazil. · Hospital Encore, Aparecida de Goiânia, GO, Brazil. · Cardiovascular Research Center, São Paulo, SP, Brazil. ·Int J Cardiovasc Imaging · Pubmed #27714601.

ABSTRACT: We sought to compare, by means of IVUS and OCT imaging, the performance of a novel sirolimus-eluting drug-eluting stent (DES) with biodegradable polymer (Inspiron™) to the Biomatrix™ DES. From the DESTINY trial, a total of 70 randomized patients (2:1) were enrolled in the IVUS substudy (Inspiron™, n = 46; Biomatrix™: n = 20) while 25 patients were evaluated with OCT (Inspiron™, n = 19; Biomatrix™: n = 06) at 9-month follow-up. The main endpoints were % of neointimal tissue obstruction (IVUS) and neointimal stut coverage (OCT) at 9 months. Patients treated with both DES had very little NIH formation at 9 months either by IVUS (% of NIH obstruction of 4.9 ± 4.1 % with Inspiron™ vs. 2.7 ± 2.9 % with Biomatrix™, p = 0.03) or by OCT (neointimal thickness of 144.2 ± 72.5 µm Inspiron™ vs. 115.0 ± 53.9 µm with Biomatrix™, p = 0.45). Regarding OCT strut-level assessment, again both devices showed excellent 9-month performance, with high rates of strut coverage (99.49 ± 1.01 % with Inspiron™ vs. 97.62 ± 2.21 % with Biomatrix™, p < 0.001) and very rare malapposition (0.29 ± 1.06 % with Inspiron™ vs. 0.53 ± 0.82 % with Biomatrix™, p = 0.44). Patients with any uncovered struts were more frequently identified in the Biomatrix™ group (9.78 ± 7.13 vs. 2.29 ± 3.91 %, p < 0.001). In the present study, midterm IVUS and OCT evaluations showed that both new generation DES with biodegradable polymer were effective in terms of suppressing excessive neointimal response, with very high rates of apposed and covered struts, suggesting a consistent and benign healing pattern.

3 Clinical Trial Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial. 2012

Hueb, Whady / Gersh, Bernard J / Rezende, Paulo Cury / Garzillo, Cibele Larrosa / Lima, Eduardo Gomes / Vieira, Ricardo D'Oliveira / Garcia, Rosa Maria Rahmi / Favarato, Desiderio / Segre, Carlos Alexandre W / Pereira, Alexandre Costa / Soares, Paulo Rogério / Ribeiro, Expedito / Lemos, Pedro / Perin, Marco A / Strunz, Célia Cassaro / Dallan, Luis A O / Jatene, Fabio B / Stolf, Noedir A G / Hueb, Alexandre Ciappina / Dias, Ricardo / Gaiotto, Fabio A / da Costa, Leandro Menezes Alves / Oikawa, Fernando Teiichi Costa / de Melo, Rodrigo Morel Vieira / Serrano, Carlos Vicente / de Ávila, Luiz Francisco Rodrigues / Villa, Alexandre Volney / Filho, José Rodrigues Parga / Nomura, César / Ramires, José A F / Kalil Filho, Roberto / Anonymous2550734. ·Heart Institute of the University of São Paulo, São Paulo, Brazil. whady.hueb@incor.usp.br ·BMC Cardiovasc Disord · Pubmed #22898311.

ABSTRACT: BACKGROUND: Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS/DESIGN: The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION: The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.

4 Article Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound. 2016

Cavalcante, Rafael / Bittencourt, Marcio S / Pinheiro, Thais L / Falcao, Breno A A / Morais, Gustavo R / Soares, Paulo / Mariani, José / Ribeiro, Expedito / Kalil-Filho, Roberto / Rochitte, Carlos E / Lemos, Pedro A. ·Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. · Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil. · Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. Electronic address: pedro.lemos@incor.usp.br. ·Atherosclerosis · Pubmed #26854972.

ABSTRACT: AIMS: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. METHODS AND RESULTS: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 ± 0.7 vessels, comprising 123.8 ± 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. CONCLUSIONS: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.

5 Article Metallic Limus-Eluting Stents Abluminally Coated with Biodegradable Polymers: Angiographic and Clinical Comparison of a Novel Ultra-Thin Sirolimus Stent Versus Biolimus Stent in the DESTINY Randomized Trial. 2015

Lemos, Pedro A / Abizaid, Alexandre A C / Meireles, George C / Sarmento-Leite, Rogério / Prudente, Mauricio / Cantarelli, Marcelo / Dourado, Adriano D / Mariani, Jose / Perin, Marco A / Costantini, Costantino / Costa, Ricardo A / Costa, José Ribamar / Chamie, Daniel / Campos, Carlos A / Ribeiro, Expedito. ·Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, SP, Brazil. · Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil. · Hospital do Servidor Público Estadual - IAMSPE, São Paulo, SP, Brazil. · Institute of Cardiology/Fundação Universitária de Cardiologia de Porto Alegre, Porto Alegre, RS, Brazil. · Hospital Encore, Aparecida de Goiania, GO, Brazil. · Hospital Bandeirantes, São Paulo, SP, Brazil. · Hospital Santa Izabel, Salvador, BA, Brazil. · Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil. · Hospital Santa Marcelina, Sao Paulo, SP, Brazil. · Hospital Cardiológico Costantini, Curitiba, PR, Brazil. ·Cardiovasc Ther · Pubmed #26352896.

ABSTRACT: AIMS: To evaluate the outcomes of patients treated with a new drug-eluting stent formulation with low doses of sirolimus, built in an ultra-thin-strut platform coated with biodegradable abluminal coating. METHODS: This study is a randomized trial that tested the main hypothesis that the angiographic late lumen loss of the novel sirolimus-eluting stent is noninferior compared with commercially available biolimus-eluting stent. A final study population comprising 170 patients with one or two de novo lesions was randomized in the ratio 2:1 for sirolimus-eluting stent or biolimus-eluting stent, respectively. The primary endpoint was 9-month angiographic in-stent late lumen loss. Adverse clinical events were prospectively collected for 1 year. RESULTS: After 9 months, the novel sirolimus-eluting stent was shown noninferior compared with the biolimus stent for the primary endpoint (angiographic in-stent late lumen loss: 0.20 ± 0.29 mm vs. 0.15 ± 0.20 mm, respectively; P value for noninferiority <0.001). The 1-year incidence of death, myocardial infarction, repeat revascularization, and stent thrombosis remained low and not significantly different between the groups. CONCLUSIONS: The present randomized trial demonstrates that the tested novel sirolimus-eluting stent was angiographically noninferior in comparison with a last-generation biolimus-eluting stent.

6 Article Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. 2014

Mariani, José / Guedes, Cristiano / Soares, Paulo / Zalc, Silvio / Campos, Carlos M / Lopes, Augusto C / Spadaro, André G / Perin, Marco A / Filho, Antonio Esteves / Takimura, Celso K / Ribeiro, Expedito / Kalil-Filho, Roberto / Edelman, Elazer R / Serruys, Patrick W / Lemos, Pedro A. ·Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. · Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. · Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Imperial College London, London, United Kingdom. · Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. Electronic address: pedro.lemos@incor.usp.br. ·JACC Cardiovasc Interv · Pubmed #25326742.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast. METHODS: A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months. RESULTS: The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI. CONCLUSIONS: Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [MOZART]; NCT01947335).

7 Article First-in-man randomised comparison of a novel sirolimus-eluting stent with abluminal biodegradable polymer and thin-strut cobalt-chromium alloy: INSPIRON-I trial. 2014

Ribeiro, Expedito E / Campos, Carlos M / Ribeiro, Henrique B / Lopes, Augusto C / Esper, Rodrigo B / Meirelles, George X / Perin, Marco A / Abizaid, Alexandre / Lemos, Pedro A. ·Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil. ·EuroIntervention · Pubmed #24755382.

ABSTRACT: AIMS: The INSPIRON-I trial is a first-in-man evaluation of the safety and efficacy of the Inspiron drug-eluting stent, a sirolimus-eluting stent with abluminal biodegradable polymer coating and thin cobalt-chromium alloy. METHODS AND RESULTS: This is a randomised, multicentre comparison between Inspiron and a stent with the same metallic structure but without polymer coating or drug elution (Cronus). The primary objective was to evaluate the in-segment late loss (LLL) at six months. Secondary endpoints included percent in-stent obstruction as measured by intravascular ultrasound (IVUS) at six months and major adverse cardiac events (MACE). Fifty-eight patients were enrolled (60 lesions), 39 for Inspiron and 19 for Cronus. Baseline clinical and angiographic characteristics of both groups were similar. At six months, the in-segment LLL was reduced in the Inspiron group compared to the control group (0.19±0.16 mm vs. 0.58±0.4 mm, respectively; p<0.001), as well as the percent neointimal obstruction (7.8±7.1% vs. 26.5±11.4%; p<0.001). At two-year follow-up, incidence of MACE was similar between groups (7.9 vs. 21.1%, respectively; p=0.20), with lower target lesion revascularisation for Inspiron (0 vs. 21.1%, respectively; p=0.01) and no stent thrombosis. CONCLUSIONS: Sirolimus eluted from an abluminal biodegradable polymer on a cobalt-chromium alloy proved effective in reducing restenosis at six months.

8 Article Extensive xanthomas and severe subclinical atherosclerosis in homozygous familial hypercholesterolemia. 2013

Rocha, Viviane Z / Chacra, Ana P M / Salgado, Wilson / Miname, Marcio / Turolla, Luciana / Gagliardi, Ana C M / Ribeiro, Expedito E / Rocha, Ricardo P S / Avila, Luiz F R / Pereira, Alexandre / Nakandakare, Edna R / Santos, Raul D. ·Heart Institute, University of São Paulo, São Paulo, Brazil. ·J Am Coll Cardiol · Pubmed #23538283.

ABSTRACT: -- No abstract --

9 Article Late clinical outcomes after implantation of drug-eluting stents coated with biodegradable polymers: 3-year follow-up of the PAINT randomised trial. 2012

Lemos, Pedro A / Moulin, Bruno / Perin, Marco A / Oliveira, Ludmilla A R R / Arruda, J Airton / Lima, Valter C / Lima, Antonio A G / Caramori, Paulo R A / Medeiros, Cesar R / Barbosa, Mauricio R / Brito, Fabio S / Ribeiro, Expedito E. ·Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, Brazil. pedro.lemos@incor.usp.br ·EuroIntervention · Pubmed #22580255.

ABSTRACT: AIMS: The long-term clinical performance of drug-eluting stents (DES) coated with biodegradable polymers is poorly known. METHODS AND RESULTS: A total of 274 coronary patients were randomly allocated to paclitaxel-eluting stents, sirolimus-eluting stents, or bare metal stents (2:2:1 ratio). The two DES used the same biodegradable polymers and were identical except for the drug. At three years, the pooled DES population had similar rates of cardiac death or myocardial infarction (9.0% vs. 7.1; p=0.6), but lower risk of repeat interventions (10.0% vs. 29.9%; p<0.01) than controls with bare stents. The cumulative 3-year incidence of definite or probable stent thrombosis in the pooled DES group was 2.3% (first year: 1.8%; second year: 0.4%; third year: zero). There were no significant differences in outcomes between paclitaxel- and sirolimus-eluting stents. CONCLUSIONS: The biodegradable-polymer coated DES releasing either paclitaxel or sirolimus were effective in reducing the 3-year rate of re-interventions.

10 Article Twelve-month clinical outcomes after coronary stenting with the Genous Bio-engineered R Stent in patients with a bifurcation lesion: from the e-HEALING (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth) registry. 2012

Beijk, Marcel A / Damman, Peter / Klomp, Margo / Woudstra, Pier / Silber, Sigmund / Grisold, Manfred / Ribeiro, Expedito E / Suryapranata, Harry / Wójcik, Jaroslaw / Sim, Kui Hian / Tijssen, Jan G P / de Winter, And Robbert J / Anonymous710723. ·Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands. ·Coron Artery Dis · Pubmed #22487946.

ABSTRACT: BACKGROUND: The e-Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth (e-HEALING) registry was designed to capture clinical data on the use of the endothelial progenitor cell capture stent (ECS) in routine clinical practice. In this analysis, we investigated the 12-month clinical outcomes in patients treated with an ECS for a bifurcation lesion. METHODS: The worldwide, prospective, nonrandomized e-HEALING registry aimed to enroll 5000 patients treated for coronary artery disease with one or more ECS between October 2005 and October 2007. Clinical follow-up was obtained at 1, 6, and 12 months. The primary endpoint was target vessel failure (TVF), defined as the composite of cardiac death, myocardial infarction, and target vessel revascularization at 12 months. RESULTS: A total of 573 patients were treated for at least one bifurcation lesion and were assessed in the current analysis. Baseline characteristics showed a median age of 65 years; 21% were diabetic patients and 36% had unstable angina. A total of 63% of the bifurcation lesions were located in the left artery descending and the mean stent length was 20.7±12.6 mm. At 12 months, TVF was 12.7% and target lesion revascularization was 7.5%. Definite or probable stent thrombosis occurred in 1.7% of the patients. Moreover, one or more stents per lesion [hazard ratio (HR): 2.79, 95% confidence interval (CI): 1.60-4.86, P<0.001], predilatation (HR: 0.39, 95% CI: 0.17-0.87, P=0.023), and lesions located in the right coronary artery (HR: 4.56, 95% CI: 1.07-19.5, P=0.041) were independent predictors of TVF. CONCLUSION: In the e-HEALING registry, coronary bifurcation stenting with the ECS results in favorable clinical outcomes and low incidences of repeat revascularization and stent thrombosis.

11 Article Duration of dual antiplatelet therapy and outcomes after coronary stenting with the Genous™ bio-engineered R stent™ in patients from the e-HEALING registry. 2012

Damman, Peter / Klomp, Margo / Silber, Sigmund / Beijk, Marcel A / Ribeiro, Expedito E / Suryapranata, Harry / Wójcik, Jaroslaw / Sim, Kui Hian / Tijssen, Jan G P / de Winter, Robbert J / Anonymous3410693. ·Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ·Catheter Cardiovasc Interv · Pubmed #21542121.

ABSTRACT: OBJECTIVE: We investigated the relation between duration of dual antiplatelet therapy (DAPT) and clinical outcomes up to 12 months after Genous™ endothelial progenitor cell capturing R stent™ placement in patients from the e-HEALING registry. BACKGROUND: Cessation of (DAPT) has been shown to be associated with the occurrence of stent thrombosis (ST). After Genous placement, 1 month of DAPT is recommended. METHODS: Patients were analyzed according to continuation or discontinuation of DAPT at a 30-day and 6-month landmark, excluding patients with events before the landmark. Each landmark was a new baseline, and outcomes were followed up to 12 months after stenting. The main outcome for our current analysis was target vessel failure (TVF), defined as target vessel-related cardiac death or myocardial infarction and target vessel revascularization. Secondary outcomes included ST. (Un)adjusted hazard ratios (HR) for TVF were calculated with Cox regression. RESULTS: No difference was observed in the incidence of TVF [HR: 1.03; 95% confidence intervals (CI): 0.65-1.65, P = 0.89] in patients continuing DAPT (n = 4,249) at 30 days versus patients stopped (n = 309), and HR: 0.82 (95% CI: 0.55-1.23, P = 0.34) in patients continuing DAPT (n = 2,654) at 6 months versus patients stopped [n = 1,408] DAPT). Furthermore, no differences were observed in ST. Even after addition of identified independent predictors for TVF, adjusted TVF hazards were comparable. CONCLUSIONS: In a post-hoc analysis of e-HEALING, duration of DAPT was not associated with the occurrence of the outcomes TVF or ST. The Genous stent may be an attractive treatment especially in patients at increased risk for (temporary) cessation of DAPT or bleeding.

12 Article Twelve-month outcomes after coronary stenting with the Genous™ bio-engineered R Stent™ in diabetic patients from the e-HEALING registry. 2011

Damman, Peter / Klomp, Margo / Beijk, Marcel A / Silber, Sigmund / Grisold, Manfred / Ribeiro, Expedito E / Suryapranata, Harry / Wójcik, Jaroslaw / Sim, Kui Hian / Tijssen, Jan Gp / DE Winter, Robbert J / Anonymous3490685. ·Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands. ·J Interv Cardiol · Pubmed #21281358.

ABSTRACT: OBJECTIVES: We compared 12-month outcomes, regarding ischemic events, repeat intervention, and ST, between diabetic and nondiabetic patients treated with the Genous™ EPC capturing R stent™ during routine nonurgent percutaneous coronary intervention (PCI) using data from the multicenter, prospective worldwide e-HEALING registry. BACKGROUND: Diabetic patients have an increased risk for restenosis and stent thrombosis (ST). METHODS: In the 4,996 patient e-HEALING registry, 273 were insulin requiring diabetics (IRD), 963 were non-IRD (NIRD), and 3,703 were nondiabetics. The 12-month primary outcome was target vessel failure (TVF), defined as target vessel-related cardiac death or myocardial infarction (MI) and target vessel revascularization. Secondary outcomes were the composite of cardiac death, MI or target lesion revascularization (TLR), and individual outcomes including ST. Cumulative event rates were estimated with the Kaplan-Meier method and compared with a log-rank test. RESULTS: TVF rates were respectively 13.4% in IRD, 9.0% in NIRD, and 7.9% in nondiabetics (P < 0.01). This was mainly driven by a higher mortality hazard in IRD (P < 0.001) and NIRD (P = 0.07), compared with nondiabetics. TLR rates were comparable in NIRD and nondiabetics, but significantly higher in IRD (P = 0.04). No difference was observed in ST. CONCLUSION: The 1-year results of the Genous stent in a real-world population of diabetics show higher TVF rates in diabetics compared with nondiabetics, mainly driven by a higher mortality hazard. IRD is associated with a significant higher TLR hazard. Definite or probable ST in all diabetic patients was comparable with nondiabetics. (J Interven Cardiol 2011;24:285-294).

13 Article Evaluation of plaque composition by intravascular ultrasound "virtual histology": the impact of dense calcium on the measurement of necrotic tissue. 2010

Sales, Fernando J R / Falcão, Breno A / Falcão, João L A / Ribeiro, Expedito E / Perin, Marco A / Horta, Pedro E / Spadaro, André G / Ambrose, John A / Martinez, Eulógio E / Furuie, Sergio S / Lemos, Pedro A. ·Heart Institute, University of São Paulo Medical School, Brazil. ·EuroIntervention · Pubmed #20884420.

ABSTRACT: AIMS: We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated. METHODS AND RESULTS: We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the "added calcium". The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of "calcium" increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p<0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p<0.01). The "added" calcium strongly predicted a proportional increase in necrosis-coded tissue in the areas surrounding the calcium-like spots (model R2=0.70; p<0.001). CONCLUSIONS: Artificial addition of calcium-like elements to the atherosclerotic plaque led to an increase in necrotic tissue in virtual histology that is probably artefactual. The overestimation of necrotic tissue by calcium strictly followed a linear pattern, indicating that it may be amenable to mathematical correction.

14 Article Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. 2010

Hueb, Whady / Lopes, Neuza / Gersh, Bernard J / Soares, Paulo R / Ribeiro, Expedito E / Pereira, Alexandre C / Favarato, Desiderio / Rocha, Antonio Sérgio C / Hueb, Alexandre C / Ramires, Jose A F. ·Heart Institute of the University of São Paulo, São Paulo, Brazil. whady.hueb@incor.usp.br ·Circulation · Pubmed #20733102.

ABSTRACT: BACKGROUND: This study compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function. METHODS AND RESULTS: The primary end points were overall mortality, Q-wave myocardial infarction, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. At a single institution, 611 patients were randomly assigned to CABG (n=203), PCI (n=205), or MT (n=203). The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT (P<0.010). The 10-year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT (P<0.001). Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG (hazard ratio 2.35, 95% confidence interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95% confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001). CONCLUSIONS: Compared with CABG, MT was associated with a significantly higher incidence of subsequent myocardial infarction, a higher rate of additional revascularization, a higher incidence of cardiac death, and consequently a 2.29-fold increased risk of combined events. PCI was associated with an increased need for further revascularization, a higher incidence of myocardial infarction, and a 1.46-fold increased risk of combined events compared with CABG. Additionally, CABG was better than MT at eliminating anginal symptoms. Clinical Trial Registration Information- URL: http://www.controlled-trials.com. REGISTRATION NUMBER: ISRCTN66068876.