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Coronary Artery Disease: HELP
Articles by Imre Ungi
Based on 19 articles published since 2010
(Why 19 articles?)
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Between 2010 and 2020, Imre Ungi wrote the following 19 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Update in the Percutaneous Management of Coronary Chronic Total Occlusions. 2018

Tajti, Peter / Burke, M Nicholas / Karmpaliotis, Dimitri / Alaswad, Khaldoon / Werner, Gerald S / Azzalini, Lorenzo / Carlino, Mauro / Patel, Mitul / Mashayekhi, Kambis / Egred, Mohaned / Krestyaninov, Oleg / Khelimskii, Dmitrii / Nicholson, William J / Ungi, Imre / Galassi, Alfredo R / Banerjee, Subhash / Brilakis, Emmanouil S. ·Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Invasive Cardiology, University of Szeged, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary. · Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. · Department of Cardiology, Columbia University, New York, New York. · Department of Cardiology, Henry Ford Hospital, Detroit, Michigan. · Medizinische Klinik I (Cardiology and Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany. · Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. · Department of Cardiology, UC San Diego Sulpizio Cardiovascular Center and VA San Diego Healthcare System, La Jolla, California. · Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany. · Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom. · Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation. · Department of Cardiology, WellSpan York Hospital, York, Pennsylvania. · Division of Invasive Cardiology, University of Szeged, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary. · Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Catania, Italy. · VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas. · Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com. ·JACC Cardiovasc Interv · Pubmed #29550088.

ABSTRACT: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup. In the current review the authors summarize the latest publications in CTO PCI and provide an overview of the current state of the field.

2 Clinical Trial ACTH- and cortisol-associated neutrophil modulation in coronary artery disease patients undergoing stent implantation. 2013

Keresztes, Margit / Horváth, Tamás / Ocsovszki, Imre / Földesi, Imre / Serfőző, Gyöngyi / Boda, Krisztina / Ungi, Imre. ·Department of Biochemistry, Medical Faculty, University of Szeged, Szeged, Hungary. keresztes.margit@med.u-szeged.hu ·PLoS One · Pubmed #23967262.

ABSTRACT: BACKGROUND: Psychosocial stress and activation of neutrophil granulocytes are increasingly recognized as major risk factors of coronary artery disease (CAD), but the possible relationship of these two factors in CAD patients is largely unexplored. Activation of neutrophils was reported to be associated with stenting; however, the issue of neutrophil state in connection with percutaneous coronary intervention (PCI) is incompletely understood from the aspect of stress and its hypothalamic-pituitary-adrenal axis (HPA) background. Thus, we aimed to study cortisol- and ACTH-associated changes in granulocyte activation in patients undergoing PCI. METHODOLOGY/PRINCIPAL FINDINGS: Blood samples of 21 stable angina pectoris (SAP) and 20 acute coronary syndrome (ACS) patients were collected directly before (pre-PCI), after (post-PCI) and on the following day of PCI (1d-PCI). Granulocyte surface L-selectin, CD15 and (neutrophil-specific) lactoferrin were analysed by flow cytometry. Plasma cortisol, ACTH, and lactoferrin, IL-6 were also assayed. In both groups, pre- and post-PCI ratios of lactoferrin-bearing neutrophils were relatively high, these percentages decreased substantially next day; similarly, 1d-PCI plasma lactoferrin was about half of the post-PCI value (all p≤0.0001). Post-PCI ACTH was reduced markedly next day, especially in ACS group (SAP: p<0.01, ACS: p≤0.0001). In ACS, elevated pre-PCI cortisol decreased considerably a day after stenting (p<0.01); in pre-PCI samples, cortisol correlated with plasma lactoferrin (r∼0.5, p<0.05). In 1d-PCI samples of both groups, ACTH showed negative associations with the ratio of lactoferrin-bearing neutrophils (SAP: r = -0.601, p<0.005; ACS: r = -0.541, p<0.05) and with plasma lactoferrin (SAP: r = -0.435, p<0.05; ACS: r = -0.609, p<0.005). CONCLUSIONS/SIGNIFICANCE: Pre- and post-PCI states were associated with increased percentage of activated/degranulated neutrophils indicated by elevated lactoferrin parameters, the 1d-PCI declines of which were associated with plasma ACTH in both groups. The correlation of plasma cortisol with plasma lactoferrin in the extremely stressed ACS before stenting, however, suggests an association of cortisol with neutrophil activation.

3 Article Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. 2019

Stone, Gregg W / Kappetein, A Pieter / Sabik, Joseph F / Pocock, Stuart J / Morice, Marie-Claude / Puskas, John / Kandzari, David E / Karmpaliotis, Dimitri / Brown, W Morris / Lembo, Nicholas J / Banning, Adrian / Merkely, Béla / Horkay, Ferenc / Boonstra, Piet W / van Boven, Ad J / Ungi, Imre / Bogáts, Gabor / Mansour, Samer / Noiseux, Nicolas / Sabaté, Manel / Pomar, Jose / Hickey, Mark / Gershlick, Anthony / Buszman, Pawel E / Bochenek, Andrzej / Schampaert, Erick / Pagé, Pierre / Modolo, Rodrigo / Gregson, John / Simonton, Charles A / Mehran, Roxana / Kosmidou, Ioanna / Généreux, Philippe / Crowley, Aaron / Dressler, Ovidiu / Serruys, Patrick W / Anonymous7621005. ·From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S., R. Mehran), the Cardiovascular Research Foundation (G.W.S., D.K., N.J.L., R. Mehran, I.K., P.G., A.C., O.D.), Mount Sinai Heart at Mount Sinai Saint Luke's (J. Puskas), and New York-Presbyterian Hospital and Columbia University Medical Center (D.K., N.J.L., I.K.) - all in New York · Erasmus Medical Center, Rotterdam (A.P.K.), Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Academic Medical Center, University of Amsterdam, Amsterdam (R. Modolo) - all in the Netherlands · University Hospitals Cleveland Medical Center, Cleveland (J.F.S.) · the London School of Hygiene and Tropical Medicine (S.J.P., J.G.) and the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), London, John Radcliffe Hospital, Oxford (A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom · Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France (M.-C.M.) · Piedmont Heart Institute, Atlanta (D.E.K., W.M.B.) · Semmelweis University, Budapest (B.M., F.H.), and the University of Szeged, Szeged (I.U., G.B.) - both in Hungary · Centre Hospitalier de l'Université de Montréal (S.M., N.N.) and Hôpital du Sacré-Coeur de Montréal (E.S., P.P., P.G.), Montreal · Hospital Clinic, Barcelona (M.S., J. Pomar) · Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.E.B., A. Bochenek) · University of Campinas, Campinas, Brazil (R. Modolo) · Abbott Vascular, Santa Clara, CA (C.A.S.) · and Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.). ·N Engl J Med · Pubmed #31562798.

ABSTRACT: BACKGROUND: Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. METHODS: We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. RESULTS: At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9 to 6.5; P = 0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). CONCLUSIONS: In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.).

4 Article Clinical outcomes in unselected patients treated with the PROMUS Element platinum-chromium, everolimus-eluting stent: Final five-year results from the PE PROVE Study. 2019

Moreno, Raul / Legrand, Victor / Ferrario, Maurizio / MacCarthy, Philip / Redwood, Simon / Werner, Nikos / Jung, Werner / Ungi, Imre / Zaman, Azfar / Richardt, Gert / Crowley, James / Schwimmbeck, Peter / Christen, Thomas / Allocco, Dominic J / Meredith, Ian T. ·Hospital La Paz, Madrid, Spain. · Centre Hospitalier Universitaire Sart Tilman, Liege, Belgium. · IRCCS Policlinico San Matteo, Pavia, Italy. · King's College Hospital, London, United Kingdom. · Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom. · Universitätsklinikum Bonn, Bonn, Germany. · Schwarzwald Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany. · Szegedi Tudományegyetem, Szeged, Hungary. · Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom. · Herzzentrum Segeberger Kliniken, Bad Segeberger, Germany. · Galway University Hospital, Galway, Ireland. · Klinikum Leverkusen, Leverkusen, Germany. · Boston Scientific Corporation, Marlborough, Massachusetts. ·Catheter Cardiovasc Interv · Pubmed #30341836.

ABSTRACT: OBJECTIVES: The goal of this analysis was to evaluate the final 5-year safety and effectiveness of the PROMUS Element platinum-chromium everolimus-eluting stent in unselected patients treated in routine clinical practice. BACKGROUND: The prospective, open-label PROMUS Element™ European Post-Approval Surveillance Study (PE-PROVE) enrolled 1,010 "real-world" patients who received the PROMUS Element stent. Adverse event rates were low at 1-year, and the incidence of stent thrombosis was 0.6%. METHODS: The primary endpoint was target vessel failure (TVF; overall and PE stent-related), a composite of cardiac death, myocardial infarction (MI) related to the target vessel, or target vessel revascularization (TVR) at 1-year post-implantation. Five-year clinical outcomes were evaluated in overall as well as high-risk patient subgroups. RESULTS: The overall 5-year TVF rate was 14.9%, with 7.0% being related to the study stent. Cardiac death, MI and TVR related to the study stent occurred in 0.5%, 3.2%, and 5.7%, respectively. Stent thrombosis through 5-year follow-up was 1.0%. The rates of overall and study stent related TVF were numerically higher in patients with medically treated diabetes, long lesions (≥28 mm), and small diameter vessels (≤2.5 mm) compared to the overall study population. Additionally, favorable stent thrombosis rates through 5 years were reported for the PROMUS Element stent in these high-risk subgroups. CONCLUSIONS: The final 5-year data from the PE-PROVE study demonstrate favorable outcomes and low rates of adverse events with the PE stent when used in "real-world" patients with coronary artery disease.

5 Article Impact of angiographic coronary artery disease complexity on ischemic and bleeding risks and on the comparative effectiveness of zotarolimus-eluting vs. bare-metal stents in uncertain drug-eluting stent candidates. 2019

Gargiulo, Giuseppe / Patialiakas, Athanasios / Piccolo, Raffaele / Thury, Attila / Colangelo, Salvatore / Campo, Gianluca / Tebaldi, Matteo / Ungi, Imre / Tondi, Stefano / Roffi, Marco / Menozzi, Alberto / de Cesare, Nicoletta / Garbo, Roberto / Meliga, Emanuele / Testa, Luca / Gabriel, Henrique Mesquita / Ferlini, Marco / Liistro, Francesco / Dellavalle, Antonio / Vranckx, Pascal / Briguori, Carlo / Windecker, Stephan / Valgimigli, Marco. ·Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Advanced Biomedical Sciences, University Federico II of Naples, Italy. · Cardiology Department, Crete Naval Hospital, Crete, Greece. · Department of Advanced Biomedical Sciences, University Federico II of Naples, Italy. · Department of Cardiology, University of Szeged, Hungary. · Interventional cardiology, San Giovanni Bosco Hospital, Torino, Italy. · Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy. · Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy. · Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Italy. · Division of Cardiology, University Hospital, Geneva, Switzerland. · Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy. · Policlinico S. Marco, IOB, Zingonia-Osio Sotto (BG), Italy. · Azienda Ospedaliera Ordine Mauriziano Torino, Italy. · Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. · Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal. · Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Cardiovascular Departments of San Donato Hospital, Arezzo, Italy. · Ospedale SS. Annunziata - Savigliano, Italy. · Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences University of Hasselt, Hasselt, Belgium. · Clinica Mediterranea, Napoli, Italy. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: marco.valgimigli@insel.ch. ·Int J Cardiol · Pubmed #30293666.

ABSTRACT: BACKGROUND: The impact of coronary artery disease (CAD) extension/complexity on outcomes and on the comparative benefits/risks of zotarolimus-eluting stent (ZES) versus bare-metal stents (BMS) remains unclear in patients at high risk of bleeding or thrombosis or at low restenosis risk. METHODS: We performed a post-hoc analysis of the ZEUS trial. The impact of coronary anatomic complexity measured by the SYNTAX score on the differences in outcomes following ZES and BMS was assessed at 1 year. RESULTS: The mean SYNTAX score was 16.3 ± 13.1 with a median of 12 (IQR: 7 to 22). We stratified patients according to SYNTAX tertiles (0-8: n = 563; >8-19 n = 532; >19: n = 511), and observed that the higher the score, the correspondingly higher was the rate of the primary endpoint of major adverse cardiovascular events (MACE) and other ischemic events, but not bleeding after adjustment. The superior efficacy of ZES versus BMS for MACE was consistent across SYNTAX tertiles (tertile 1: HR 0.71, 95% CI 0.44-1.13; tertile 2: HR 0.71, 95% CI 0.46-1.09; tertile 3: HR 0.83, 95% CI 0.61-1.10) without significant heterogeneity (p for trend = 0.55). This between-groups difference mainly reflected a reduction in MI and TVR without effect on mortality. There was no significant interaction between the SYNTAX score and allocated stent type with respect to ischemic and bleeding endpoints. CONCLUSIONS: The SYNTAX score was predictor of major adverse cardiovascular events but not bleeding and ZES provided superior efficacy and safety than BMS across the whole spectrum of CAD complexity. SYNTAX score may be routinely used for the assessment of the ischemic risk (but not bleeding) after PCI and should not guide the decision-making for DES versus BMS in patients undergoing PCI.

6 Article Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention. 2018

Kandzari, David E / Gershlick, Anthony H / Serruys, Patrick W / Leon, Martin B / Morice, Marie-Claude / Simonton, Charles A / Lembo, Nicholas J / Banning, Adrian P / Merkely, Béla / van Boven, Ad J / Ungi, Imre / Kappetein, Arie Pieter / Sabik, Joseph F / Généreux, Philippe / Dressler, Ovidiu / Stone, Gregg W. ·Piedmont Heart Institute, Atlanta, GA (D.E.K.). · Leicester Biomedical Research Centre, University Hospitals of Leicester, University of Leicester, United Kingdom (A.H.G.). · Imperial College of Science, Technology and Medicine, London, United Kingdom (P.W.S.). · Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.). · Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.). · Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France (M.-C.M.). · Abbott Vascular, Inc, Santa Clara, CA (C.A.S.). · John Radcliffe Hospital, Oxford, United Kingdom (A.P.B.). · Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.). · Medisch Centrum Leeuwarden, The Netherlands (A.J.v.B.). · Cardiology Center, University of Szeged, Hungary (I.U.). · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (A.P.K.). · Department of Surgery, UH Cleveland Medical Center, OH (J.F.S.). · Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.). · Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.). ·Circ Cardiovasc Interv · Pubmed #30354633.

ABSTRACT: BACKGROUND: Distal left main (LM) coronary artery bifurcation disease increases percutaneous coronary intervention (PCI) procedural complexity and is associated with worse outcomes than isolated ostial/shaft disease. The optimal treatment strategy for distal LM disease is undetermined. We sought to determine whether outcomes after PCI of LM distal bifurcation lesions are influenced by treatment with a provisional 1-stent versus planned 2-stent technique, and if so, whether such differences are conditioned by the complexity of the LM bifurcation lesion. METHODS AND RESULTS: The clinical and angiographic characteristics, procedural methods and outcomes, and clinical events through 3-year follow-up were compared in patients undergoing distal LM PCI with a 1-stent provisional versus planned 2-stent technique in the EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization). Among 529 patients undergoing planned distal LM PCI, 344 (65.0%) and 185 (35.0%) were treated with intended 1-stent provisional and planned 2-stent techniques, respectively. The primary composite end point rate of death, myocardial infarction, or stroke at 3 years was significantly lower in patients treated with the provisional 1-stent versus planned 2-stent method (14.1% versus 20.7%; adjusted hazard ratio, 0.55; 95% CI, 0.35-0.88; P=0.01), driven by differences in cardiovascular death (3.3% versus 8.3%, P=0.01) and myocardial infarction (7.7% versus 12.8%, P=0.06). The 3-year rate of ischemia-driven revascularization of the LM complex was also lower in the provisional group (7.2% versus 16.3%, P=0.001). In 342 patients with distal LM bifurcation disease that did not involve both major side branch vessels, the 3-year primary end point was lower with a provisional 1-stent versus planned 2-stent technique (13.8% versus 23.3%, P=0.04), whereas no significant difference was present in 182 patients with distal LM bifurcation disease that did involve both side branch vessels (14.3% versus 19.2%, P=0.36). CONCLUSIONS: Among patients with distal LM bifurcation disease in the EXCEL trial randomized to PCI, 3-year adverse outcomes were worse with planned 2-stent treatment compared with a provisional 1-stent approach, a difference that was confined to patients without major involvement of both LM side branch vessels. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01205776.

7 Article Contemporary Use of Laser During Percutaneous Coronary Interventions: Insights from the Laser Veterans Affairs (LAVA) Multicenter Registry. 2018

Karacsonyi, Judit / Armstrong, Ehrin J / Truong, Huu Tam D / Tsuda, Ryan / Kokkinidis, Damianos G / Martinez-Parachini, Jose Roberto / Alame, Aya J / Danek, Barbara A / Karatasakis, Aris / Roesle, Michele / Khalili, Houman / Ungi, Imre / Banerjee, Subhash / Brilakis, Emmanouil S / Rangan, Bavana V. ·Dallas VA Medical Center, 4500 S. Lancaster Road (151/3S), Dallas, TX 75216 USA. bavana@gmail.com. ·J Invasive Cardiol · Pubmed #29543185.

ABSTRACT: BACKGROUND: The contemporary use and outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention (PCI) are not well described. METHODS: We examined the baseline clinical and angiographic characteristics and procedural outcomes of 130 target lesions in 121 consecutive PCIs (n = 116 patients) in which ELCA was performed at three United States Department of Veterans Affairs (VA) medical centers between 2008 and 2016. RESULTS: Mean age was 68.5 ± 9 years and 97% of the patients were men. Patients had high prevalence of diabetes mellitus (63%), prior coronary artery bypass graft surgery (41%), and prior myocardial infarction (60%). The most common target vessel was the left anterior descending (32%), followed by the right coronary artery (30%), circumflex artery (20%), and saphenous vein graft (12%). The target lesions were highly complex, with moderate/severe calcification in 62% and in-stent restenosis in 37%. The most common indication for ELCA was balloon-uncrossable lesions (43.8%), followed by balloon-undilatable lesions (40.8%) and thrombotic lesions (12.3%). Use of ELCA was associated with high technical success rate (90.0%) and procedural success rate (88.8%), and low major adverse cardiac event (MACE) rate (3.45%). Mean procedure time was 120 min (interquartile range [IQR], 81-191 min), air kerma radiation dose was 2.76 Gy (IQR, 1.32-5.01 Gy), and contrast volume was 273 mL (IQR, 201-362 mL). CONCLUSION: In a contemporary multicenter United States registry, ELCA was commonly used in highly complex lesions and was associated with high technical and procedural success rates and low incidence of MACE.

8 Article Management of Guidewire Entrapment With Laser Atherectomy. 2017

Karacsonyi, Judit / Martinez-Parachini, Jose R / Danek, Barbara A / Karatasakis, Aris / Ungi, Imre / Banerjee, Subhash / Brilakis, Emmanouil S. ·Minneapolis Heart Institute, 920 East 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com. ·J Invasive Cardiol · Pubmed #28441644.

ABSTRACT: A 62-year-old man was referred for percutaneous coronary intervention of a severe circumflex lesion. The guidewire became entangled in the previously implanted left anterior descending artery stent. The left main was engaged with a second guide catheter, followed by balloon dilations, various microcatheters, and laser atherectomy. The wire eventually fractured without protruding into the aorta. The circumflex lesion was stented with two stents, followed by left main stenting that covered the fragment. Caution should be used when wiring through stents; wire fracture can be treated with stent implantation, as long as the wire fragment does not protrude into the aorta.

9 Article Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients: The GLAGOV Randomized Clinical Trial. 2016

Nicholls, Stephen J / Puri, Rishi / Anderson, Todd / Ballantyne, Christie M / Cho, Leslie / Kastelein, John J P / Koenig, Wolfgang / Somaratne, Ransi / Kassahun, Helina / Yang, Jingyuan / Wasserman, Scott M / Scott, Robert / Ungi, Imre / Podolec, Jakub / Ophuis, Antonius Oude / Cornel, Jan H / Borgman, Marilyn / Brennan, Danielle M / Nissen, Steven E. ·South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia2Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio. · Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio. · Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. · The Methodist DeBakey Heart and Vascular Center, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas. · Academic Medical Center, Department of Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany7DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany8Department of Internal Medicine, University of Ulm Medical Center, Ulm, Germany. · Amgen Inc, Thousand Oaks, California. · Department of Cardiology, University of Szeged, Hungary. · Department of Interventional Cardiology, Cardiology Institute, Jagiellonian University, College of Medicine and the John Paul II Hospital, Krakow, Poland. · Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands. · Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands. ·JAMA · Pubmed #27846344.

ABSTRACT: Importance: Reducing levels of low-density lipoprotein cholesterol (LDL-C) with intensive statin therapy reduces progression of coronary atherosclerosis in proportion to achieved LDL-C levels. Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors produce incremental LDL-C lowering in statin-treated patients; however, the effects of these drugs on coronary atherosclerosis have not been evaluated. Objective: To determine the effects of PCSK9 inhibition with evolocumab on progression of coronary atherosclerosis in statin-treated patients. Design, Setting, and Participants: The GLAGOV multicenter, double-blind, placebo-controlled, randomized clinical trial (enrollment May 3, 2013, to January 12, 2015) conducted at 197 academic and community hospitals in North America, Europe, South America, Asia, Australia, and South Africa and enrolling 968 patients presenting for coronary angiography. Interventions: Participants with angiographic coronary disease were randomized to receive monthly evolocumab (420 mg) (n = 484) or placebo (n = 484) via subcutaneous injection for 76 weeks, in addition to statins. Main Outcomes and Measures: The primary efficacy measure was the nominal change in percent atheroma volume (PAV) from baseline to week 78, measured by serial intravascular ultrasonography (IVUS) imaging. Secondary efficacy measures were nominal change in normalized total atheroma volume (TAV) and percentage of patients demonstrating plaque regression. Safety and tolerability were also evaluated. Results: Among the 968 treated patients (mean age, 59.8 years [SD, 9.2]; 269 [27.8%] women; mean LDL-C level, 92.5 mg/dL [SD, 27.2]), 846 had evaluable imaging at follow-up. Compared with placebo, the evolocumab group achieved lower mean, time-weighted LDL-C levels (93.0 vs 36.6 mg/dL; difference, -56.5 mg/dL [95% CI, -59.7 to -53.4]; P < .001). The primary efficacy parameter, PAV, increased 0.05% with placebo and decreased 0.95% with evolocumab (difference, -1.0% [95% CI, -1.8% to -0.64%]; P < .001). The secondary efficacy parameter, normalized TAV, decreased 0.9 mm3 with placebo and 5.8 mm3 with evolocumab (difference, -4.9 mm3 [95% CI, -7.3 to -2.5]; P < .001). Evolocumab induced plaque regression in a greater percentage of patients than placebo (64.3% vs 47.3%; difference, 17.0% [95% CI, 10.4% to 23.6%]; P < .001 for PAV and 61.5% vs 48.9%; difference, 12.5% [95% CI, 5.9% to 19.2%]; P < .001 for TAV). Conclusions and Relevance: Among patients with angiographic coronary disease treated with statins, addition of evolocumab, compared with placebo, resulted in a greater decrease in PAV after 76 weeks of treatment. Further studies are needed to assess the effects of PCSK9 inhibition on clinical outcomes. Trial Registration: clinicaltrials.gov Identifier: NCT01813422.

10 Article Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. 2016

Stone, Gregg W / Sabik, Joseph F / Serruys, Patrick W / Simonton, Charles A / Généreux, Philippe / Puskas, John / Kandzari, David E / Morice, Marie-Claude / Lembo, Nicholas / Brown, W Morris / Taggart, David P / Banning, Adrian / Merkely, Béla / Horkay, Ferenc / Boonstra, Piet W / van Boven, Ad J / Ungi, Imre / Bogáts, Gabor / Mansour, Samer / Noiseux, Nicolas / Sabaté, Manel / Pomar, José / Hickey, Mark / Gershlick, Anthony / Buszman, Pawel / Bochenek, Andrzej / Schampaert, Erick / Pagé, Pierre / Dressler, Ovidiu / Kosmidou, Ioanna / Mehran, Roxana / Pocock, Stuart J / Kappetein, A Pieter / Anonymous230886. ·From New York Presbyterian Hospital and Columbia University Medical Center (G.W.S.), the Cardiovascular Research Foundation (G.W.S., P.G., O.D., I.K., R.M.), and Mount Sinai Medical Center (J. Puskas, R.M.), New York · the Cleveland Clinic Foundation, Cleveland (J.F.S.) · the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London (P.W.S.), and London School of Hygiene and Tropical Medicine (S.J.P.), London, Oxford University Hospitals, Oxford (D.P.T., A. Banning), and University Hospitals of Leicester NHS Trust, Leicester (M.H., A.G.) - all in the United Kingdom · Abbott Vascular, Santa Clara, CA (C.A.S.) · Hôpital du Sacré-Coeur de Montréal (P.G., E.S., P.P.) and Centre Hospitalier de l'Université de Montréal, Hôpital Hôtel-Dieu de Montréal (S.M., N.N.), Montreal · Piedmont Hospital, Atlanta (D.E.K., N.L., W.M.B.) · Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France (M.-C.M.) · Semmelweis University, Budapest (B.M., F.H.) and University of Szeged, Szeged (I.U., G.B.) - both in Hungary · Medisch Centrum Leeuwarden, Leeuwarden (P.W.B., A.J.B.), and Erasmus Medical Center, Rotterdam (A.P.K.) - both in the Netherlands · Hospital Clinic, Barcelona (M.S., J. Pomar) · and Medical University of Silesia, Katowice, and American Heart of Poland, Ustron - both in Poland (P.B., A. Bochenek). ·N Engl J Med · Pubmed #27797291.

ABSTRACT: BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P<0.001 for noninferiority, P=0.008 for superiority). The secondary end-point event of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years occurred in 23.1% of the patients in the PCI group and in 19.1% in the CABG group (P=0.01 for noninferiority, P=0.10 for superiority). CONCLUSIONS: In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776 .).

11 Article Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention?: A Pre-Specified Analysis From the ZEUS Trial. 2016

Ariotti, Sara / Adamo, Marianna / Costa, Francesco / Patialiakas, Athanasios / Briguori, Carlo / Thury, Attila / Colangelo, Salvatore / Campo, Gianluca / Tebaldi, Matteo / Ungi, Imre / Tondi, Stefano / Roffi, Marco / Menozzi, Alberto / de Cesare, Nicoletta / Garbo, Roberto / Meliga, Emanuele / Testa, Luca / Gabriel, Henrique Mesquita / Ferlini, Marco / Vranckx, Pascal / Valgimigli, Marco / Anonymous1140861. ·Swiss Cardiovascular Center Bern, Inselspital, Bern University Hospital, Switzerland; Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands. · Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands. · Cardiology Department, Crete Naval Hospital, Crete, Greece. · Clinica Mediterranea, Napoli, Italy. · Cardiology Center, Szeged, Hungary. · Interventional Cardiology, San Giovanni Bosco Hospital, Torino, Italy. · Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Ferrara, Italy. · Azienda Unità Sanitaria Locale di Modena-Ospedale Baggiovara, Italy. · Division of Cardiology, University Hospital, Geneva, Switzerland. · Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy. · Policlinico S. Marco, Zingonia (Bergamo), Italy. · Azienda Ospedaliera Ordine Mauriziano, Torino, Italy. · Interventional Cardiology, Ist. Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy. · Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal. · Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Virga Jesse Ziekenhuis, Hasselt, Belgium. · Swiss Cardiovascular Center Bern, Inselspital, Bern University Hospital, Switzerland; Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands. Electronic address: marco.valgimigli@insel.ch. ·JACC Cardiovasc Interv · Pubmed #26965932.

ABSTRACT: OBJECTIVES: This study sought to investigate the ischemic and bleeding outcomes of patients fulfilling high bleeding risk (HBR) criteria who were randomized to zotarolimus-eluting Endeavor Sprint stent (E-ZES) or bare-metal stent (BMS) implantation followed by an abbreviated dual antiplatelet therapy (DAPT) duration for stable or unstable coronary artery disease. BACKGROUND: DES instead of BMS use remains controversial in HBR patients, in whom long-term DAPT poses safety concerns. METHODS: The ZEUS (Zotarolimus-Eluting Endeavor Sprint Stent in Uncertain DES Candidates) is a multinational, randomized single-blinded trial that randomized among others, in a stratified manner, 828 patients fulfilling pre-defined clinical or biochemical HBR criteria-including advanced age, indication to oral anticoagulants or other pro-hemorrhagic medications, history of bleeding and known anemia-to receive E-ZES or BMS followed by a protocol-mandated 30-day DAPT regimen. The primary endpoint of the study was the 12-month major adverse cardiovascular event rate, consisting of death, myocardial infarction, or target vessel revascularization. RESULTS: Compared with patients without, those with 1 or more HBR criteria had worse outcomes, owing to higher ischemic and bleeding risks. Among HBR patients, major adverse cardiovascular events occurred in 22.6% of the E-ZES and 29% of the BMS patients (hazard ratio: 0.75; 95% confidence interval: 0.57 to 0.98; p = 0.033), driven by lower myocardial infarction (3.5% vs. 10.4%; p < 0.001) and target vessel revascularization (5.9% vs. 11.4%; p = 0.005) rates in the E-ZES arm. The composite of definite or probable stent thrombosis was significantly reduced in E-ZES recipients, whereas bleeding events did not differ between stent groups. CONCLUSIONS: Among HBR patients with stable or unstable coronary artery disease, E-ZES implantation provides superior efficacy and safety as compared with conventional BMS. (Zotarolimus-Eluting Endeavor Sprint Stent in Uncertain DES Candidates [ZEUS]; NCT01385319).

12 Article Outcomes of a dedicated stent in coronary bifurcations with large side branches: A subanalysis of the randomized TRYTON bifurcation study. 2016

Généreux, Philippe / Kini, Annapoorna / Lesiak, Maciej / Kumsars, Indulis / Fontos, Géza / Slagboom, Ton / Ungi, Imre / Metzger, D Christopher / Wykrzykowska, Joanna J / Stella, Pieter R / Bartorelli, Antonio L / Fearon, William F / Lefèvre, Thierry / Feldman, Robert L / Tarantini, Giuseppe / Bettinger, Nicolas / Minalu Ayele, Girma / LaSalle, Laura / Francese, Dominic P / Onuma, Yoshinobu / Grundeken, Maik J / Garcia-Garcia, Hector M / Laak, Linda L / Cutlip, Donald E / Kaplan, Aaron V / Serruys, Patrick W / Leon, Martin B. ·Columbia University Medical Center/NewYork Presbyterian Hospital, New York, New York. · Cardiovascular Research Foundation, New York, New York. · Hôpital Du Sacré-Coeur De Montréal, Université De Montréal, Montréal, Québec, Canada. · Mount Sinai Medical Center, New York, New York. · 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland. · Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia. · Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary. · Department of Cardiology, OLVG, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. · 2nd Department of Medicine and Cardiology Center Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged- Department of Cardiology, Szeged, Hungary. · Wellmont CVA Heart Institute, Kingsport, Tennessee. · Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Interventional Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. · Centro Cardiologico Monzino, University of Milan, Milan, Italy. · Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California. · Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France. · MediQuest Research Group, Ocala, Florida. · Azienda Ospedaliera Di Padova, Padova, Italy. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Tryton Medical Inc., Durham, North Carolina. · Harvard Clinical Research Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon. ·Catheter Cardiovasc Interv · Pubmed #26397982.

ABSTRACT: OBJECTIVES: To examine the benefit of the Tryton dedicated side branch (SB) stent compared with provisional stenting in the treatment of complex bifurcation lesions involving large SBs. BACKGROUND: The TRYTON Trial was designed to evaluate the utility of a dedicated SB stent to treat true bifurcation lesions involving large (≥2.5 mm by visual estimation) SBs. Patient enrolled in the trial had smaller SB diameters than intended (59% SB ≤2.25 mm by Core Lab QCA). The TRYTON Trial did not meet its primary endpoint due to an increased rate of peri-procedural myocardial infarctions (MIs). METHODS: The TRYTON Trial randomized 704 patients to the Tryton SB stent with main vessel DES versus provisional SB treatment with main vessel DES. The rates of the primary end point of target vessel failure and the secondary powered end point of angiographic percent diameter stenosis in the SB at 9 months were assessed and compared between the two treatment strategies among patients with a SB ≥2.25 mm diameter at baseline determined by Core Lab QCA. RESULTS: Among the 704 patients enrolled in the TRYTON Trial, 289 patients (143 provisional and 146 Tryton stent; 41% of entire cohort) had a SB ≥2.25 mm. The primary end point of TVF was numerically lower in the Tryton group compared with the provisional group (11.3% vs. 15.6%, P = 0.38), and was within the non-inferiority margin. No difference among the rates of clinically driven target vessel revascularization (3.5% vs. 4.3% P = 0.77) or cardiac death (0% both groups) were seen. In-segment percent diameter stenosis of the SB was significantly lower in the Tryton group compared with the provisional group (30.4% vs. 40.6%, P = 0.004). CONCLUSIONS: Analysis of the TRYTON Trial cohort of SB ≥2.25 mm supports the safety and efficacy of the Tryton SB stent compared with a provisional stenting strategy in the treatment of bifurcation lesions involving large SBs. © 2015 Wiley Periodicals, Inc.

13 Article Serum lipids and cardiac function correlate with nitrotyrosine and MMP activity in coronary artery disease patients. 2015

Bencsik, Péter / Sasi, Viktor / Kiss, Krisztina / Kupai, Krisztina / Kolossváry, Márton / Maurovich-Horvat, Pál / Csont, Tamás / Ungi, Imre / Merkely, Béla / Ferdinandy, Péter. ·Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged, Hungary. · Pharmahungary Group, Szeged, Hungary. · Division of Invasive Cardiology, Second Department of Internal Medicine and Center of Cardiology, University of Szeged, Szeged, Hungary. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Metabolic Diseases and Cell Signaling Research Group, Department of Biochemistry, University of Szeged, Budapest, Hungary. · Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary. ·Eur J Clin Invest · Pubmed #25944577.

ABSTRACT: AIMS: Peroxynitrite-matrix metalloproteinase (MMP) signalling has been shown to contribute to myocardial ischaemia/reperfusion injury and heart failure and to be influenced by hyperlipidaemia in preclinical models. Therefore, here we investigated the correlation between the markers of peroxynitrite-MMP signalling and hyperlipidaemia in patients with significant coronary stenosis. METHODS: Five minutes before percutaneous coronary intervention (PCI), arterial blood samples were collected from 36 consecutive patients with coronary artery disease (CAD) selected for elective PCI. RESULTS: Serum nitrotyrosine positively correlated with MMP-9 activity (r = 0·54, P = 0·01), but not with MMP-2 activity. Nitrotyrosine positively correlated with total (r = 0·58; P < 0·01) and LDL cholesterol (r = 0·55; P < 0·01), serum triglyceride (r = 0·47; P < 0·05), and creatinine (r = 0·42; P < 0·05) and negatively correlated with HDL cholesterol (r = -0·46; P < 0·05) and with left ventricular ejection fraction (LVEF; r = -0·55; P < 0·05), respectively. MMP-2 activity correlated positively with total (r = 0·55; P < 0·05) and LDL cholesterol (r = 0·45; P < 0·05). In statin-treated patients, a significantly reduced serum nitrotyrosine was found as compared to statin naives; however, MMP activities and serum cholesterol levels were not different. MMP-9 activity correlated with urea nitrogen (r = 0·42; P < 0·05) and LVEF (r = -0·73; P < 0·01). Serum creatinine correlated negatively with LVEF (r = -0·50, P < 0·01). CONCLUSIONS: This is the first demonstration that (i) serum nitrotyrosine correlates with MMP-9 activity, (ii) lipid parameters correlate with nitrotyrosine and MMP-2 activity, (iii) myocardial function correlates with creatinine, nitrotyrosine and MMP-9 activity, and (iv) creatinine correlates with nitrotyrosine and urea nitrogen with MMP-9 activity in patients with CAD. Studying the biomarkers of peroxynitrite-MMP pathway in large prospective trials may reveal their diagnostic avails.

14 Article Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting stent candidates. 2015

Valgimigli, Marco / Patialiakas, Athanasios / Thury, Attila / McFadden, Eugene / Colangelo, Salvatore / Campo, Gianluca / Tebaldi, Matteo / Ungi, Imre / Tondi, Stefano / Roffi, Marco / Menozzi, Alberto / de Cesare, Nicoletta / Garbo, Roberto / Meliga, Emanuele / Testa, Luca / Gabriel, Henrique Mesquita / Airoldi, Flavio / Ferlini, Marco / Liistro, Francesco / Dellavalle, Antonio / Vranckx, Pascal / Briguori, Carlo / Anonymous960822. ·Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: m.valgimigli@erasmusmc.nl. · Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy; Cardiology Department, Crete Naval Hospital, Crete, Greece. · Cardiology Center and University of Szeged, Szeged, Hungary. · Division of Cardiology, Cork University Hospital, Cork, Ireland. · Interventional Cardiology, San Giovanni Bosco Hospital, Torino, Italy. · Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy. · Azienda Unità Sanitaria Locale di Modena-Ospedale, Baggiovara, Italy. · Division of Cardiology, University Hospital, Geneva, Switzerland. · Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. · Policlinico S. Marco Zingonia, Bergamo, Italy. · Azienda Ospedaliera Ordine Mauriziano, Torino, Italy. · Interventional Cardiology, Ist. Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy. · Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal. · IRCCS Multimedica Sesto San Giovanni, Milan, Italy. · Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Cardiovascular Departments of San Donato Hospital, Arezzo, Italy. · Ospedali Riuniti, Savigliano, Italy. · Virga Jesse Ziekenhuis, Hasselt, Belgium. · Clinica Mediterranea, Napoli, Italy. ·J Am Coll Cardiol · Pubmed #25720624.

ABSTRACT: BACKGROUND: The use of drug-eluting stents (DES) in patients at high risk of bleeding or thrombosis has not been prospectively studied; limited data are available in patients who have a low restenosis risk. OBJECTIVES: This study sought to compare a hydrophilic polymer-based, second-generation zotarolimus-eluting stent (ZES) with a unique drug fast-release profile versus bare-metal stents (BMS) under similar durations of dual-antiplatelet therapy (DAPT). METHODS: We randomly assigned 1,606 patients with stable or unstable symptoms, and who on the basis of thrombotic bleeding or restenosis risk criteria, qualified as uncertain candidates for DES, to receive ZES or BMS. DAPT duration was on the basis of patient characteristics, rather than stent characteristics, and allowed for a personalized 1-month dual antiplatelet regimen. The primary endpoint was the risk of 1-year major adverse cardiovascular events (MACE), which included death, myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS: Median DAPT duration was 32 days (interquartile range [IQR]: 30 to 180 days) and did not differ between the groups. In the ZES group, 140 patients (17.5%) reached the primary endpoint, compared with 178 patients (22.1%) in the BMS group (hazard ratio: 0.76; 95% confidence interval: 0.61 to 0.95; p = 0.011) as a result of lower MI (2.9% vs. 8.1%; p < 0.001) and TVR rates (5.9% vs.10.7%; p = 0.001) in the ZES group. Definite or probable stent thrombosis was also significantly reduced in ZES recipients (2.0% vs. 4.1%; p = 0.019). CONCLUSIONS: Compared with BMS, DES implantation using a stent with a biocompatible polymer and fast drug-eluting characteristics, combined with an abbreviated, tailored DAPT regimen, resulted in a lower risk of 1-year MACE in uncertain candidates for DES implantation. (Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates [ZEUS] Study; NCT01385319).

15 Article 6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial. 2015

Gilard, Martine / Barragan, Paul / Noryani, Arif A L / Noor, Hussam A / Majwal, Talib / Hovasse, Thomas / Castellant, Philippe / Schneeberger, Michel / Maillard, Luc / Bressolette, Erwan / Wojcik, Jaroslaw / Delarche, Nicolas / Blanchard, Didier / Jouve, Bernard / Ormezzano, Olivier / Paganelli, Franck / Levy, Gilles / Sainsous, Joël / Carrie, Didier / Furber, Alain / Berland, Jacques / Darremont, Oliver / Le Breton, Hervé / Lyuycx-Bore, Anne / Gommeaux, Antoine / Cassat, Claude / Kermarrec, Alain / Cazaux, Pierre / Druelles, Philippe / Dauphin, Raphael / Armengaud, Jean / Dupouy, Patrick / Champagnac, Didier / Ohlmann, Patrick / Endresen, Knut / Benamer, Hakim / Kiss, Robert Gabor / Ungi, Imre / Boschat, Jacques / Morice, Marie-Claude. ·Department of Cardiology, Brest University, Brest, France. Electronic address: Martine.gilard@chu-brest.fr. · Polyclinique les Fleurs, Ollioules, France. · Al Qassimi Hospital, Sharjah, United Arab Emirates. · Bahrain Defence Force West, Riffa, Bahrain. · Dubai Hospital, Dubai, United Arab Emirates. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · Department of Cardiology, Brest University, Brest, France. · Hôpital Albert Schweitzer, Colmar, France. · Clinique Axium, Aix en Provence, France. · Nouvelles Cliniques Nantaises, Nantes, France. · Klinika Kardiologii SPSK4, Lublin, Poland. · Centre Hospitalier Mitterrand, Pau, France. · Clinique Saint Gatien, Tours, France. · Centre Hospitalier, Aix en Provence, France. · Centre Hospitalier Universitaire de Grenoble, Grenoble, France. · Centre Hospitalier Universitaire, Hôpital Nord, Marseille, France. · Clinique du Millénaire, Montpellier, France. · Clinique Rhône Durance, Avignon, France. · Centre Hospitalier Universitaire, Toulouse, France. · Centre Hospitalier Universitaire, Angers, France. · Clinique Saint Hilaire, Rouen, France. · Clinique Saint Augustin, Bordeaux, France. · Centre Hospitalier Universitaire, Rennes, France. · Centre Hospitalier, Compiègne, France. · Polyclinique de Bois, Bernard, France. · Centre Hospitalier Universitaire, Limoges, France. · Centre Hospitalier, Vannes, France. · Centre Hospitalier, Lorient, France. · Poly de Saint Laurent, Rennes, France. · Hôpital de la Croix Rousse, Lyon France. · Clinique Esquirol, Agen, France. · Hôpital Privé, Antony, France. · Clinique Tonkin, Villeurbanne, France. · Centre Hospitalier Universitaire, Strasbourg, France. · Oslo Universitetssykehus, Oslo, Norway. · Hôpital La Roseraie, Aubervilliers, France. · MH Egrszsegugyi Kozpont, Budapest, Hungary. · Honvéd Kórház, Budapest, Hungary, and University of Szeged, Szent-Györgyi Albert, Szeged, Hungary. ·J Am Coll Cardiol · Pubmed #25461690.

ABSTRACT: BACKGROUND: The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months to reduce the risk of late stent thrombosis, particularly in those with acute coronary syndrome (ACS). OBJECTIVES: This study hypothesized that antiplatelet treatment with DAPT for 6 months may be noninferior to 24-month DAPT in aspirin-sensitive patients. METHODS: A multicenter, randomized study assigned patients undergoing implantation of everolimus-eluting stents with confirmed nonresistance to aspirin to receive 6- or 24-month DAPT. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke, and major bleeding at 12 months post-stenting. RESULTS: A total of 2,031 patients were enrolled in 70 European and Middle Eastern centers. The trial was prematurely terminated due to recruitment problems, leaving 941 patients randomized to 24-month DAPT and 953 to 6-month DAPT. The 2 treatment groups had similar baseline and procedural characteristics. There was no significant difference in the primary endpoint (24-month: 1.5% vs. 6-month: 1.6%; p = 0.85). Noninferiority was demonstrated for 6- versus 24-month DAPT, with an absolute risk difference of 0.11% (95% confidence interval: -1.04% to 1.26%; p for noninferiority = 0.0002). There were no significant differences in stent thrombosis or bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ (hazard ratio: 1.7 [95% confidence interval: 0.519 to 6.057; p = 0.361]). CONCLUSIONS: Rates of bleeding and thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. (Is There A LIfe for DES After Discontinuation of Clopidogrel [ITALICplus]; NCT01476020).

16 Article Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study. 2011

Ruzsa, Zoltán / Pálinkás, Attila / Forster, Tamás / Ungi, Imre / Varga, Albert. ·Department of Medicine and Cardiology Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, H-6724, Szeged, Pécsi str, 4, Hungary. ·Cardiovasc Ultrasound · Pubmed #21672192.

ABSTRACT: BACKGROUND: the clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions. METHODS: 27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM. RESULTS: interpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis. CONCLUSION: In angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.

17 Article Simultaneous improvement in aortic distensibility and coronary flow velocity reserve after successful coronary interventions. 2010

Nemes, Attila / Ungi, Imre / Csanády, Miklós / Forster, Tamás. ·2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, H-6720 Szeged, Hungary. nemes@in2nd.szote.u-szeged.hu ·Echocardiography · Pubmed #20113329.

ABSTRACT: OBJECTIVE: Deteriorations in coronary flow velocity reserve (CFR) and aortic distensibility have been demonstrated in coronary artery disease. The objective of the present study was a simultaneous echocardiographic evaluation of the CFR and aortic distensibility indices before and after successful percutaneous coronary interventions (PCI) in patients with left anterior descending coronary artery (LAD) disease. METHODS: The study population, comprising 12 patients (4 women and 8 men) with significant proximal LAD stenosis, were compared with matched controls. Transesophageal echocardiography (TEE) was carried out to evaluate the CFR and aortic distensibility indices (the aortic elastic modulus E(p) and Young's circumferential static elastic modulus E(s)) before and after PCI to the LAD. The subjects underwent TEE on average 8 +/- 11 days before PCI and 25 +/- 6 weeks after PCI. RESULTS: An improvement in CFR was demonstrated in patients with LAD stenosis after successful PCI (1.71 +/- 0.36 vs. 2.08 +/- 0.28, P < 0.05), which paralleled the decreases in E(p) (936 +/- 544 mmHg vs. 567 +/- 184 mmHg, P < 0.05) and E(s) (10,207 +/- 6,295 mmHg vs. 5,831 +/- 2,010 mmHg, P < 0.05) during the follow-up. CONCLUSION: The aortic distensibility improves in parallel with the increase in CFR in patients with LAD stenosis after successful PCI.

18 Minor Intracoronary thrombus on optical coherence tomography in a patient with variant angina: treatment and follow-up. 2014

Hausinger, Péter / Ungi, Imre / Szántó, Gyula / Hajtman, László / Forster, Tamás / Regar, Evelyn / Thury, Attila. ·Invasive Cardiology Unit, Cardiology Center, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary. · Department of Cardiology, Thoraxcenter, BA-585, Erasmus University Medical Center, Rotterdam, The Netherlands. · Invasive Cardiology Unit, Cardiology Center, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary. Electronic address: thury.attila@med.u-szeged.hu. ·Int J Cardiol · Pubmed #25085379.

ABSTRACT: -- No abstract --

19 Minor Detection of perfusion abnormalities on coronary angiograms in hypertension by myocardium selective densitometric perfusion assessments. 2012

Nemes, Attila / Kalapos, Anita / Sasi, Viktor / Ungi, Tamás / Nagy, Ferenc Tamás / Zimmermann, Zsolt / Forster, Tamás / Ungi, Imre. · ·Int J Cardiol · Pubmed #22531317.

ABSTRACT: -- No abstract --