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Coronary Artery Disease: HELP
Articles from Universita Vita-Salute San Raffaele
Based on 191 articles published since 2008
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These are the 191 published articles about Coronary Artery Disease that originated from Universita Vita-Salute San Raffaele during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Editorial Bioresorbable Scaffolds: A Complex Journey to the "Promised Land". 2017

Colombo, Antonio / Azzalini, Lorenzo. ·Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it. · Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. ·JACC Cardiovasc Interv · Pubmed #29216998.

ABSTRACT: -- No abstract --

2 Editorial Percutaneous treatment of left main disease: Still learning about the optimal PCI strategy. 2016

Ancona, Marco / Chieffo, Alaide. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. ·Cardiovasc Revasc Med · Pubmed #27988083.

ABSTRACT: -- No abstract --

3 Editorial A coronary solution to manage a vascular peripheral obstruction post transcatheter aortic valve implantation. 2016

Yazdani, Kaveh O / Jabbour, Richard J / Mangieri, Antonio / Cacucci, Michele / Colombo, Antonio / Latib, Azeem. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Cardiology Department, Ospedale Maggiore, Crema, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it. ·Int J Cardiol · Pubmed #27522383.

ABSTRACT: -- No abstract --

4 Editorial The Clinical Significance and Management Implications of Chronic Total Occlusion Associated With Surgical Coronary Artery Revascularization. 2016

Azzalini, Lorenzo. ·San Raffaele Scientific Institute, Milan, Italy. Electronic address: azzalini.lorenzo@hsr.it. ·Can J Cardiol · Pubmed #27140947.

ABSTRACT: -- No abstract --

5 Editorial Experience and accuracy can result in parity of outcomes following one or two stents for left main stem bifurcation disease. 2015

Colombo, Antonio / Ruparelia, Neil. ·Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy. · EMO-GVM, Centro Cuore Columbus, Milan, Italy. · Imperial College, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #25999274.

ABSTRACT: -- No abstract --

6 Editorial When you ask yourself the question "should I protect the side branch?": the answer is "yes". 2015

Colombo, Antonio / Ruparelia, Neil. ·San Raffaele Scientific Institute, Milan, Italy. Electronic address: info@emocolumbus.it. · San Raffaele Scientific Institute, Milan, Italy; Imperial College, London, United Kingdom. ·JACC Cardiovasc Interv · Pubmed #25616816.

ABSTRACT: -- No abstract --

7 Editorial Decision making between percutaneous coronary intervention or bypass surgery in multi-vessel coronary disease. 2014

Buchanan, Gill Louise / Giustino, Gennaro / Chieffo, Alaide. ·Department of Cardiology, North Cumbria University Hospitals NHS Trust, Carlisle, United Kingdom. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. Electronic address: chieffo.alaide@hsr.it. ·Rev Esp Cardiol (Engl Ed) · Pubmed #24863589.

ABSTRACT: -- No abstract --

8 Editorial Coronary stenosis and transmural perfusion across the left ventricular wall. 2014

Camici, Paolo G / Rimoldi, Ornella E. ·Vita Salute University and Scientific Institute, San Raffaele, Milan, Italy camici.paolo@hsr.it. · Vita Salute University and Scientific Institute, San Raffaele, Milan, Italy CNR IBFM Segrate, Italy. ·Eur Heart J · Pubmed #24847153.

ABSTRACT: -- No abstract --

9 Editorial Is "the bigger the better" still valid for drug-eluting stents? 2014

Panoulas, Vasileios F / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; National Heart and Lung Institute (Division of ICL), Imperial College London, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #24753167.

ABSTRACT: -- No abstract --

10 Editorial One versus two stents: the cause or the effect? 2014

Colombo, Antonio / Chieffo, Alaide. ·Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it. · Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy. ·JACC Cardiovasc Interv · Pubmed #24529930.

ABSTRACT: -- No abstract --

11 Review Percutaneous coronary intervention or coronary artery bypass graft in left main coronary artery disease: a comprehensive meta-analysis of adjusted observational studies and randomized controlled trials. 2018

Bertaina, Maurizio / De Filippo, Ovidio / Iannaccone, Mario / Colombo, Antonio / Stone, Gregg / Serruys, Patrick / Mancone, Massimo / Omedè, Pierluigi / Conrotto, Federico / Pennone, Mauro / Kimura, Takeshi / Kawamoto, Hiroyoshi / Zoccai, Giuseppe Biondi / Sheiban, Imad / Templin, Christian / Benedetto, Umberto / Cavalcante, Rafael / D'Amico, Maurizio / Gaudino, Mario / Moretti, Claudio / Gaita, Fiorenzo / D'Ascenzo, Fabrizio. ·Division of Cardiology, Città Della Salute e della Scienza, Molinette Hospital, Turin. · Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. · Cardiovascular Research and Education Columbia University Medical Center, Presbyterian Hospital, New York, USA. · Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome, Rome, Italy. · Department of Cardiovascular Medicine, Kyoto University, Japan. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina. · Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli. · Cardiology Department, Pederzoli Hospital, Verona, Italy. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA. ·J Cardiovasc Med (Hagerstown) · Pubmed #30095584.

ABSTRACT: BACKGROUND: Treatment of patients with ULMCA (unprotected left main coronary artery disease) with percutaneous coronary intervention (PCI) has been compared with coronary artery bypass graft (CABG), without conclusive results. METHODS: All randomized controlled trials (RCTs) and observational studies with multivariate analysis comparing PCI and CABG for ULMCA were included. Major cardiovascular events (MACEs, composite of all-cause death, MI, definite or probable ST, target vessel revascularization and stroke) were the primary end points, whereas its single components were the secondary ones, along with stent thrombosis, graft occlusion and in-hospital death and stroke. Subgroup analyses were performed according to Syntax score. RESULTS: Six RCTs (4717 patients) and 20 observational studies with multivariate adjustment (14 597 patients) were included. After 5 (3-5.5) years, MACE rate was higher for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14], without difference in death, whereas more relevant risk of MI was because of observational studies. Coronary stenting increased risk of revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression, performance of PCI was improved by use of intra-coronary imaging and worsened by first generation stents, whereas two arterial grafts increased benefit of CABG. For patients with Syntax score less than 22, MACE rates did not differ, whereas for higher values, CABG reduced MACE because of lower risk of revascularization. Incidence of graft occlusion was 3.24% (2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced stent thrombosis. CONCLUSION: Surgical revascularization reduces risk of revascularization for ULMCA patients, especially for those with Syntax score greater than 22, with a higher risk of in-hospital death. Intra-coronary imaging and use of arterial grafts improved performance of revascularization strategies.

12 Review Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. 2017

D'Ascenzo, Fabrizio / Iannaccone, Mario / Saint-Hilary, Gaelle / Bertaina, Maurizio / Schulz-Schüpke, Stefanie / Wahn Lee, Cheol / Chieffo, Alaide / Helft, Gerard / Gili, Sebastiano / Barbero, Umberto / Biondi Zoccai, Giuseppe / Moretti, Claudio / Ugo, Fabrizio / D'Amico, Maurizio / Garbo, Roberto / Stone, Gregg / Rettegno, Sara / Omedè, Pierluigi / Conrotto, Federico / Templin, Christian / Colombo, Antonio / Park, Seung-Jung / Kastrati, Adnan / Hildick-Smith, David / Gasparini, Mauro / Gaita, Fiorenzo. ·Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy. · Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy. · Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy. · Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany. · Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy. · Department of Cardiology, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France. · Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland. · Department of Cardiology, La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100 Latina, Italy. · Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy. · Department of Cardiology, Columbia University Medical Center, USA Cardiovascular Research Foundation, 161 Ft. Washington Ave. Herbert Irving Pavilion 6th Floor, New York, NY 10032 212.305.7060, USA. · Department of Cardiology, Sussex Cardiac Centre, Barry Building, Eastern Rd, Brighton BN2 5BE, UK. ·Eur Heart J · Pubmed #29020300.

ABSTRACT: Aims: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined. Methods and results: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT. Conclusion: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

13 Review Current Risk of Contrast-Induced Acute Kidney Injury After Coronary Angiography and Intervention: A Reappraisal of the Literature. 2017

Azzalini, Lorenzo / Candilio, Luciano / McCullough, Peter A / Colombo, Antonio. ·Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: azzalini.lorenzo@hsr.it. · Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. · Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center and Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA. ·Can J Cardiol · Pubmed #28941604.

ABSTRACT: Contrast-induced acute kidney injury (CI-AKI) is the acute impairment of renal function further to the intravascular administration of iodinated contrast media, and occurs most frequently after coronary angiography, percutaneous coronary intervention, and contrast-enhanced computed tomography. CI-AKI has been associated with the development of acute renal failure, worsening of chronic kidney disease, requirement for dialysis, prolonged hospital stay, and higher mortality rates and health care costs. Recently, a number of studies suggested that contrast media exposure might not be the causative agent in the occurrence of acute kidney injury, particularly in stable patients who receive small to moderate amounts of contrast media. However, those who undergo coronary angiography and intervention are indeed subject to an increased hazard of CI-AKI, in view of a more significant contrast media exposure as well as the presence of concomitant risk factors. Solid randomized clinical trials are therefore required to identify preventative strategies to reduce the risk of CI-AKI and its complications in these patients.

14 Review Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory? 2017

Colombo, Antonio / Giannini, Francesco / Briguori, Carlo. ·Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it. · Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy. ·J Am Coll Cardiol · Pubmed #28750704.

ABSTRACT: The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration. Here, we aim to provide reasons as to why we still need BMS in our cardiac catheterization laboratory.

15 Review Cardiotoxicity in oncology and coronary microcirculation: future challenges in theranostics. 2017

Peretto, Giovanni / Lazzeroni, Davide / Sartorio, Carmem L / Camici, Paolo G. ·Department of Cardiovascular Diseases, Vita Salute University and San Raffaele Hospital, Milan, Italy. · Department of Cardiovascular Diseases, Vita Salute University and San Raffaele Hospital, Milan, Italy, and Prevention and Rehabilitation Unit, Fondazione Don Gnocchi, Parma, Italy. · Department of Cardiovascular Diseases, Vita Salute University and San Raffaele Hospital, Milan, Italy, carmemsartorio@gmail.com. ·Front Biosci (Landmark Ed) · Pubmed #28410144.

ABSTRACT: Many of the patients undergoing chemotherapy or radiotherapy for cancer are at increased risk of developing cardiovascular diseases. Recent evidence suggests that cardiac dysfunction and subsequent heart failure are mainly due to vascular toxicity rather than only to due to myocyte toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by epicardial coronary artery disease. In fact, in the last decades, it has been found that myocardial ischemia may occur as a consequence of structural or functional dysfunction of the complex network of vessels, which cannot be seen by a coronary angiography: the coronary microcirculation. Nowadays many diagnostic and therapeutic options are available both in coronary microvascular dysfunction and cardio-oncology. Aim of this review is to suggest future theranostic implications of the relationship between cardiotoxicity in oncology and coronary microvascular dysfunction, showing common pathophysiologic mechanisms, proposing new diagnostic approaches and therapeutic options for cardioprotection.

16 Review Hybrid Percutaneous Coronary Intervention With Bioresorbable Vascular Scaffolds in Combination With Drug-Eluting Stents or Drug-Coated Balloons for Complex Coronary Lesions. 2017

Tanaka, Akihito / Jabbour, Richard J / Mitomo, Satoru / Latib, Azeem / Colombo, Antonio. ·Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Imperial College London, London, United Kingdom. · Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. Electronic address: info@emocolumbus.it. ·JACC Cardiovasc Interv · Pubmed #28335892.

ABSTRACT: Bioresorbable vascular scaffolds (BVS) have become an attractive option in the percutaneous coronary intervention field due to the potential advantages associated with the complete resorption process that occurs within a few years. However, current-generation BVS have several limitations including thicker struts, reduced radial strength, and limited expansion capability when compared with drug-eluting stents (DES). As a result, complex coronary disease often contains BVS-inappropriate/unfavorable segments. This does not necessarily mean that BVS use must be completely avoided, and minimizing the length of permanent metallic caging may still be advantageous. Operators should fully understand the limitations of current BVS, and when to consider a hybrid strategy of BVS in combination with DES or drug-coated balloons.

17 Review Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. 2017

Costa, Francesco / van Klaveren, David / James, Stefan / Heg, Dik / Räber, Lorenz / Feres, Fausto / Pilgrim, Thomas / Hong, Myeong-Ki / Kim, Hyo-Soo / Colombo, Antonio / Steg, Philippe Gabriel / Zanchin, Thomas / Palmerini, Tullio / Wallentin, Lars / Bhatt, Deepak L / Stone, Gregg W / Windecker, Stephan / Steyerberg, Ewout W / Valgimigli, Marco / Anonymous4670899. ·Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; Erasmus University Medical Center, Rotterdam, Netherlands; Department of Clinical and Experimental Medicine, Policlinic "G Martino", University of Messina, Messina, Italy. · Erasmus University Medical Center, Rotterdam, Netherlands; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. · Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. · Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Severance Cardiovascular Hospital, Yonsei University College of Medicine and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. · EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy. · Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France. · Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA. · Erasmus University Medical Center, Rotterdam, Netherlands. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: marco.valgimigli@insel.ch. ·Lancet · Pubmed #28290994.

ABSTRACT: BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y METHODS: A total of 14 963 patients treated with DAPT after coronary stenting-largely consisting of aspirin and clopidogrel and without indication to oral anticoagulation-were pooled at a single-patient level from eight multicentre randomised clinical trials with independent adjudication of events. Using Cox proportional hazards regression, we identified predictors of out-of-hospital Thrombosis in Myocardial Infarction (TIMI) major or minor bleeding stratified by trial, and developed a numerical bleeding risk score. The predictive performance of the novel score was assessed in the derivation cohort and validated in patients treated with percutaneous coronary intervention from the PLATelet inhibition and patient Outcomes (PLATO) trial (n=8595) and BernPCI registry (n=6172). The novel score was assessed within patients randomised to different DAPT durations (n=10 081) to identify the effect on bleeding and ischaemia of a long (12-24 months) or short (3-6 months) treatment in relation to baseline bleeding risk. FINDINGS: The PRECISE-DAPT score (age, creatinine clearance, haemoglobin, white-blood-cell count, and previous spontaneous bleeding) showed a c-index for out-of-hospital TIMI major or minor bleeding of 0·73 (95% CI 0·61-0·85) in the derivation cohort, and 0·70 (0·65-0·74) in the PLATO trial validation cohort and 0·66 (0·61-0·71) in the BernPCI registry validation cohort. A longer DAPT duration significantly increased bleeding in patients at high risk (score ≥25), but not in those with lower risk profiles (p INTERPRETATION: The PRECISE-DAPT score is a simple five-item risk score, which provides a standardised tool for the prediction of out-of-hospital bleeding during DAPT. In the context of a comprehensive clinical evaluation process, this tool can support clinical decision making for treatment duration. FUNDING: None.

18 Review Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. 2017

Palmerini, Tullio / Della Riva, Diego / Benedetto, Umberto / Bacchi Reggiani, Letizia / Feres, Fausto / Abizaid, Alexandre / Gilard, Martine / Morice, Marie-Claude / Valgimigli, Marco / Hong, Myeong-Ki / Kim, Byeong-Keuk / Jang, Yangsoo / Kim, Hyo-Soo / Park, Kyung Woo / Colombo, Antonio / Chieffo, Alaide / Sangiorgi, Diego / Biondi-Zoccai, Giuseppe / Généreux, Philippe / Angelini, Gianni D / Pufulete, Maria / White, Jonathon / Bhatt, Deepak L / Stone, Gregg W. ·Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy. · Bristol Heart Institute, University of Bristol School of Clinical Sciences, Bristol, Bristol, UK. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Department of Cardiology, Brest University, Brest, France. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · Swiss Cardiovascular Center, Bern, Switzerland. · Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · San Raffaele Scientific Institute, Milan, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA. ·Eur Heart J · Pubmed #28110296.

ABSTRACT: Aim: We sought to determine whether the optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) placement varies according to clinical presentation. Methods and Results: We performed an individual patient data pairwise and network meta-analysis comparing short-term (≤6-months) versus long-term (1-year) DAPT as well as 3-month vs. 6-month vs 1-year DAPT. The primary study outcome was the 1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST). Six trials were included in which DAPT after DES consisted of aspirin and clopidogrel. Among 11 473 randomized patients 6714 (58.5%) had stable CAD and 4758 (41.5%) presented with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina. In ACS patients, ≤6-month DAPT was associated with non-significantly higher 1-year rates of MI or ST compared with 1-year DAPT (Hazard Ratio (HR) 1.48, 95% Confidence interval (CI) 0.98-2.22; P = 0.059), whereas in stable patients rates of MI and ST were similar between the two DAPT strategies (HR 0.93, 95%CI 0.65-1.35; P = 0.71; Pinteraction = 0.09). By network meta-analysis, 3-month DAPT, but not 6-month DAPT, was associated with higher rates of MI or ST in ACS, whereas no significant differences were apparent in stable patients. Short DAPT was associated with lower rates of major bleeding compared with 1-year DAPT, irrespective of clinical presentation. All-cause mortality was not significantly different with short vs. long DAPT in both patients with stable CAD and ACS. Conclusions: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks.

19 Review Ivabradine in Patients with Stable Coronary Artery Disease: A Rationale for Use in Addition to and Beyond Percutaneous Coronary Intervention. 2017

Godino, Cosmo / Colombo, Antonio / Margonato, Alberto. ·Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. cosmogodino@gmail.com. · Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. · EMO-GVM Centro Cuore Columbus, Milan, Italy. ·Clin Drug Investig · Pubmed #27766510.

ABSTRACT: Heart rate is an established prognostic marker for longevity and is an important contributor in the pathophysiology of various cardiovascular diseases, including ischemic heart disease and heart failure. Most ischemic episodes are triggered by an increase in heart rate, which causes an imbalance between myocardial oxygen delivery and consumption. In addition, increased heart rate is a modifiable risk factor for chronic heart failure. Ivabradine, an inhibitor of I

20 Review Left Main Percutaneous Coronary Intervention. 2016

Ruparelia, Neil / Chieffo, Alaide. ·Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK. · Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy. Electronic address: alaide.chieffo@hsr.it. ·Interv Cardiol Clin · Pubmed #28582198.

ABSTRACT: Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.

21 Review Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease. 2016

Testa, Luca / Latib, Azeem / Montone, Rocco A / Colombo, Antonio / Bedogni, Francesco. ·From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.) · and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.). ·Circ Cardiovasc Interv · Pubmed #27412870.

ABSTRACT: Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).

22 Review Bioresorbable Scaffolds for the Management of Coronary Bifurcation Lesions. 2016

Kawamoto, Hiroyoshi / Ruparelia, Neil / Tanaka, Akihito / Chieffo, Alaide / Latib, Azeem / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College, London, United Kingdom. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it. ·JACC Cardiovasc Interv · Pubmed #27198679.

ABSTRACT: The use of bioresorbable scaffolds (BRS) may be associated with benefits including restoration of endothelial function, positive vessel remodeling, and reduced risk for very late (stent) thrombosis compared with metallic stents by virtue of their complete absorption within 3 to 4 years of implantation. When treating bifurcation lesions, these advantages may be even more pronounced. The aim of this review is to summarize current experiences and technical considerations of bifurcation treatment with BRS. Because of the physical properties of current-generation BRS, there are concerns with regard to the efficacy and safety of this novel technology for the treatment of bifurcations, with the potential for increased rates of scaffold thrombosis and side-branch occlusions, and as a consequence, bifurcations have been excluded from the major BRS trials. Nevertheless, BRS have been used for this indication in clinical practice, as evidenced by "real-world" registries. Considering the potential limitations, specific technical considerations and modified bifurcation strategies should be used in an attempt to attenuate problems and achieve optimal procedural and clinical outcomes.

23 Review Bioresorbable scaffolds for treatment of coronary bifurcation lesions: Critical appraisal and future perspectives. 2016

Diletti, Roberto / Tchetche, Didier / Barbato, Emanuele / Latib, Azeem / Farah, Bruno / van Geuns, Robert-Jan / Colombo, Antonio / Fajadet, Jean / van Mieghem, Nicolas M. ·Department of Interventional Cardiology, Thoraxcenter Erasmus MC, Rotterdam, the Netherlands. r.diletti@erasmusmc.nl. · Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France. · Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Department of Interventional Cardiology, Thoraxcenter Erasmus MC, Rotterdam, the Netherlands. ·Catheter Cardiovasc Interv · Pubmed #27143281.

ABSTRACT: Bioresorbable vascular scaffolds have been recently introduced as a novel paradigm for coronary artery disease treatment allowing temporary vessel support and drug delivery without indefinite coronary caging, potentially reducing the long-term limitation of metallic stents. The scientific community has rapidly embraced this concept and bioresorbable devices have been introduced in clinical practice. However, despite the fact that bifurcation lesions represent a large and challenging subset in the field of interventional cardiology, this subgroup of lesions have been avoided in the initial experience with bioresorbable scaffolds and clear recommendations on methodological approaches are lacking. In the present report, we describe the various techniques for bifurcation treatment with bioresorbable scaffolds and the theoretical advantages and disadvantages of this technology in different scenarios, with a glimpse to challenging subsets and possible complications. Therefore, we aim to provide experience based insights and practical guidance for bioresorbable scaffold implantation in bifurcation lesions. © 2016 Wiley Periodicals, Inc.

24 Review Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents. 2016

D'Ascenzo, Fabrizio / Moretti, Claudio / Bianco, Matteo / Bernardi, Alessandro / Taha, Salma / Cerrato, Enrico / Omedè, Pierluigi / Montefusco, Antonio / Frangieh, Antonio H / Lee, Cheol W / Campo, Gianluca / Chieffo, Alaide / Quadri, Giorgio / Pavani, Marco / Zoccai, Giuseppe B / Gaita, Fiorenzo / Park, Seung-Jung / Colombo, Antonio / Templin, Christian / Lüscher, Thomas F / Stone, Gregg W. ·Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. Electronic address: meshmeshaya11@yahoo.com. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. · Division of Cardiology, A.O.U San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. · Cardiology Department, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy; Cardiology Department, LTTA Center, Ferrara, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. ·Am J Cardiol · Pubmed #27134057.

ABSTRACT: The purpose of the study was to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention, especially in the era of second-generation drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months) DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death, myocardial infarction (MI), stent thrombosis (ST), and major bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering everolimus-eluting and fast-release zotarolimus-eluting stents separately. Shorter DAPT was inferior to longer DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major bleeding was reduced by shorter DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion, DAPT for ≤6 months is reasonable for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents, with the benefit of less major bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to DAPT duration should take into account the competing risks of bleeding and ischemic complications after present-generation DES.

25 Review Ivabradine in chronic stable angina: Effects by and beyond heart rate reduction. 2016

Camici, Paolo G / Gloekler, Steffen / Levy, Bernard I / Skalidis, Emmanouil / Tagliamonte, Ercole / Vardas, Panos / Heusch, Gerd. ·Vita Salute University, San Raffaele Hospital, Milan, Italy. Electronic address: camici.paolo@hsr.it. · Cardiology, Cardiovascular Department, University Hospital Bern, Bern, Switzerland. · PARCC, INSERM U970, Vessels and Blood Institute, Hôpital Lariboisière, Paris, France. · Cardiology Department, University Hospital of Heraklion, Crete, Greece. · Cardiology Division, "Umberto I" Hospital, Nocera Inferiore, SA, Italy. · Cardiology Department, University Hospital of Heraklion, Greece. · Institute for Pathophysiology, West German Heart and Vascular Centre Essen, University of Essen Medical School, Essen, Germany. ·Int J Cardiol · Pubmed #27104917.

ABSTRACT: Heart rate plays a major role in myocardial ischemia. A high heart rate increases myocardial performance and oxygen demand and reduces diastolic time. Ivabradine reduces heart rate by inhibiting the If current of sinoatrial-node cells. In contrast to beta-blockers, ivabradine has no negative inotropic and lusitropic effect for a comparable heart rate reduction. Consequently, diastolic duration is increased with ivabradine compared to beta-blockers. This has potential consequences on coronary blood flow since compression of the vasculature by the surrounding myocardium during systole impedes flow and coronary blood flow is mainly diastolic. Moreover, ivabradine does not unmask alpha-adrenergic vasoconstriction and, unlike beta-blockers, maintains coronary dilation during exercise. In comparison with beta-blockers, ivabradine increases coronary flow reserve and collateral perfusion promoting the development of coronary collaterals. Ivabradine attenuates myocardial ischemia and its consequences even in the absence of heart rate reduction, possibly through reduced formation of reactive oxygen species. In conclusion, ivabradine differs from other anti-anginal agents by improving coronary blood flow and by additional pleiotropic effects. These properties make ivabradine an effective anti-anginal and anti-ischemic agent for the treatment of patients with coronary artery disease.

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