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Coronary Artery Disease: HELP
Articles by Mark S. Spence
Based on 2 articles published since 2009
(Why 2 articles?)
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Between 2009 and 2019, Mark S. Spence wrote the following 2 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Article Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. 2016

Mäkikallio, Timo / Holm, Niels R / Lindsay, Mitchell / Spence, Mark S / Erglis, Andrejs / Menown, Ian B A / Trovik, Thor / Eskola, Markku / Romppanen, Hannu / Kellerth, Thomas / Ravkilde, Jan / Jensen, Lisette O / Kalinauskas, Gintaras / Linder, Rikard B A / Pentikainen, Markku / Hervold, Anders / Banning, Adrian / Zaman, Azfar / Cotton, Jamen / Eriksen, Erlend / Margus, Sulev / Sørensen, Henrik T / Nielsen, Per H / Niemelä, Matti / Kervinen, Kari / Lassen, Jens F / Maeng, Michael / Oldroyd, Keith / Berg, Geoff / Walsh, Simon J / Hanratty, Colm G / Kumsars, Indulis / Stradins, Peteris / Steigen, Terje K / Fröbert, Ole / Graham, Alastair N J / Endresen, Petter C / Corbascio, Matthias / Kajander, Olli / Trivedi, Uday / Hartikainen, Juha / Anttila, Vesa / Hildick-Smith, David / Thuesen, Leif / Christiansen, Evald H / Anonymous831283. ·Department of Cardiology, Oulu University Hospital, Oulu, Finland. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Department of Cardiology, Golden Jubilee National Hospital, Clydebank, Scotland. · Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland. · Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia. · Craigavon Cardiac Centre, Craigavon, Northern Ireland. · Department of Cardiology, University of Northern Norway, Tromsø, Norway. · Heart Hospital, Tampere University Hospital, Tampere, Finland. · Heart Center, Kuopio University Hospital, Kuopio, Finland. · Department of Cardiology, Örebro University Hospital, Örebro, Sweden. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Vilnius University Hospital, Vilnius, Lithuania. · Department of Cardiology, Danderyd Hospital, Stockholm, Sweden. · Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. · Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Oxford Heart Centre, Oxford, UK. · Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle, UK. · Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK. · Department of Cardiology, Haukeland University Hospital, Bergen, Norway. · Department of Cardiology, East Tallinn Hospital, Tallinn, Estonia. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA. · Department of Cardiac Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Department of Cardiovascular Surgery, University of Northern Norway, Tromsø, Norway. · Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK. · Department of Cardiac Surgery, Oulu University Hospital, Finland. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. Electronic address: evald.christiansen@dadlnet.dk. ·Lancet · Pubmed #27810312.

ABSTRACT: BACKGROUND: Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. METHODS: In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. FINDINGS: Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11-1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18-2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67-1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40-5·90, p=0·0040) for non-procedural myocardial infarction, 16% versus 10% (1·50, 1·04-2·17, p=0·032) for any revascularisation, and 5% versus 2% (2·25, 0·93-5·48, p=0·073) for stroke. INTERPRETATION: The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease. FUNDING: Biosensors, Aarhus University Hospital, and participating sites.

2 Article A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery. 2014

Shand, James A / Sharma, Divyesh / Hanratty, Colm / McClelland, Anthony / Menown, Ian B A / Spence, Mark S / Richardson, Geoffrey / Herity, Niall A / Walsh, Simon J. ·St James's Hospital, Dublin, Ireland; Department of Cardiology, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #24167078.

ABSTRACT: OBJECTIVES: To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS. BACKGROUND: There is no prospective data examining the need, feasibility, and safety of over-expansion of current generation DES beyond nominal diameter. METHODS: Patients with flow-limiting coronary atheroma requiring IVUS assessment of the LMS were recruited. Standardized measurements of the distal LMS were made. Subsequently, patients requiring post dilation of current generation DES within the LMS were entered into a PCI registry. RESULTS: Overall, 125 patients were recruited into the initial study. Mean cross-sectional area (CSA) of the distal LMS was 22.6 mm(2) (SD ± 5.4 mm(2) ). Mean maximal vessel diameter was 5.7 mm (SD ± 0.7 mm). Increasing plaque burden was associated with reduced CSA (P < 0.001). In 31 consecutive patients undergoing IVUS guided PCI of the LMS with 5.5 and 6.0 mm balloon catheters, mean maximal stent diameters were >5.0 mm with the Biomatrix Flex 9 crown and Promus Element Large vessel platforms. No intraprocedural complications occurred. Mean follow up was 13.4 months. Clinical restenosis rate was 3.2%, with 2 deaths unrelated to index procedure. CONCLUSIONS: The majority of patients with angiographic coronary atheroma have a mean LMS diameter of >4 mm indicating the requirement for post dilation beyond nominal diameter all of current generation DES in almost all patients when treating the LMS. This is achievable with current DES platforms with no intraprocedural complication. Clinical follow up indicates excellent short-term efficacy.