Author(s) Al-Tawil M.; Chikhal R.; Abdelhaliem A. (amrhaliem@gmail.com)
Institution(s) (Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
(Chikhal) Hull York Medical School, University of York, York, United Kingdom
(Abdelhaliem) Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
Source Journal of Cardiac Surgery; 2021
Language English
Database EMBASE
AbstractBackground: Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. Aim(s): This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD. Material(s) and Method(s): We carried out a literature search using multiple electronic databases including PUBMED and Scopus in order to collate research evidence on intervention timeframe and outcomes of TEVAR in un-TBAD. Result(s): Performing TEVAR during the subacute phase of dissection (15-90 days since symptom onset) seems to be associated with less periprocedural complications compared to the acute phase, however, late outcomes (>30 days post-TEVAR) are comparable between the two groups and are superior to the chronic phase. Discussion(s): The introduction of TEVAR in un-TBAD presents a paradigm shift in the management of un-TBAD and a potential move towards becoming the gold-standard treatment option for un-TBAD. Intervening with TEVAR within the first 90 days since symptom onset (acute and subacute un-TBAD) gives favourable outcomes relative to intervention in the chronic phase of dissection (>90 days since symptom onset), this is due to the dissecting septum becoming less compliant over time. Conclusion(s): TEVAR is a safe and effective treatment modality for un-TBAD with a survival benefit compared to OMT alone. Offering TEVAR during the subacute phase of dissection yields optimal results which are comparable to the acute phase but superior to the chronic phase.Copyright © 2021 Wiley Periodicals LLC

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Author(s) Haque A. (adam.haque@manchester.ac.uk); Al-Khaffaf H.
Institution(s) (Haque, Al-Khaffaf) Cumbria and Lancashire Vascular and Endovascular Centre, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, United Kingdom
Source Annals of Vascular Surgery; 2021
Language English
Database EMBASE
AbstractBackground: The association of dialysis fistulas and heart failure is believed to be due to high cardiac output. N-terminal pro-B-Type Natriuretic Peptide (pro-BNP) which is secreted by the cardiac ventricles in response to excessive stretching of the myocytes has been used as a marker of heart failure with 90% sensitivity. We report our early experience using pro-BNP levels to test the efficacy of the novel 'secondary extension technique' (SET) in improving myocardial function by reducing fistula flow. Method(s): Eleven patients with high fistula flows (>3000 mL/m, all brachio-cephalic) and raised pro-BNP underwent SET between 2011 and 2015. SET involves extending the anastomosis from brachial to either proximal radial or ulnar arteries. We measured pro-BNP levels, fistula flow and clinical improvements both pre and post operatively. Result(s): SET resulted in a median (IQR) flow rate decrease of 57.9 (11.9)% which correlated with a fall in pro-BNP of 69.6 (39)%. Seven of the 11 patients in the series pro-BNP level returned to a normal value at average follow-up of 3 months post SET. All patients had HOF-related symptom resolution post-procedure and remained asymptomatic at last follow-up Conclusion(s): Our pilot data suggests that SET is an effective way of reducing fistula flow. It also shows that BNP may be a reliable biomarker in assessing the impact of the technique on cardiac function. These results warrant further investigation in the form of a definitive, multicenter study.Copyright © 2021

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Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1680-1691
Language English
Publication Date Oct 2021
DOI 10.1007/s00392-021-01922-y
ISSN 1861-0684
Database EMBASE
Abstract
Aims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization.

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Author(s) Tan S.Z.C.P.; El Santawy H.; Abdelhaliem A.
Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3831-3833
Language English
Publication Date Oct 2021
DOI 10.1111/jocs.15828
ISSN 0886-0440
Database EMBASE
Abstract
Thoracic endovascular aortic repair (TEVAR) has quickly become the mainstay of treatment for acute aortic dissection, in particular cases of acute complicated Stanford Type B dissection (co-TBAD). Necessarily, TEVAR carries with it the risk of postoperative complications, including stroke and renal failure. As a result, the management of patients with uncomplicated type B aortic dissection (un-TBAD), which is generally accepted as being less severe, is safely managed via optimal medical therapy (OMT) alone. However, despite OMT, patients with un-TBAD are at substantial risk of severe disease progression requiring delayed intervention. The cost-benefit ratio associated with TEVAR for un-TBAD is therefore of key interest. Howard and colleagues produced a fascinating systematic review and meta-analysis investigating the clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their data suggest that there is no significant difference in in-hospital mortality or 5-year survival between TEVAR for un-TBAD and co-TBAD, although the 30-day mortality rate appeared to be higher in the co-TBAD cohort. Patients with co-TBAD appeared to also be at a higher risk of postoperative stroke and TEVAR endoleak, while un-TBAD patients were at a higher risk of postoperative renal failure. Further prospective research into these relationships is recommended to fully elucidate the comparative efficacies of TEVAR for un-TBAD and co-TBAD.

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Author(s) Wang R.; Onuma Y.; Serruys P.W.; van Geuns R.J.; Takahashi K. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1543-1553
Language English
Publication Date Oct 2021
DOI 10.1007/s00392-020-01802-x
ISSN 1861-0684
Database EMBASE
Abstract
Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and Results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04-1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54-2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion(s): Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. 

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Author(s) Bashir ; Mohammed, Idhrees; Mousavizadeh, Mostafa; Rezaei, Yousef; Hosseini, Saeid
Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3994-3995
Language English
Publication Date Oct 2021
DOI 10.1111/jocs.15837
ISSN 08860440
Database CINAHL

• Available in full text at Journal of cardiac surgery from Wiley Online Library 

Authors Mousavizadeh M.; Daliri M.; Aljadayel H.A.; Mohammed I.; Rezaei Y.; Bashir M.
Source Journal of cardiac surgery; Sep 2021; Vol. 36(9)
Abstract The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

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Author(s) Meharban N. (Drmobashir@outlook.com); Munir W.; Idhrees M.; Bashir A.; Bashir M.
Source Asian Cardiovascular and Thoracic Annals; 2021
AbstractPenetrating atherosclerotic ulcers present with an insidious onset with a reported mortality of 9%, varying across populations. With vast arrays of risk factors and potentially ominous complications, it is vital to efficiently provide optimum strategies for management. There exists controversy in the literature regarding management, especially for Type B penetrating atherosclerotic ulcers; the decision-making framework encompasses numerous factors in considerations for medical management versus invasive intervention and choice of endovascular versus open repair in the latter. The concomitant presence of intramural haematoma adds further complexity to the already intricate decision-making for management. We performed searches through PubMed and SCOPUS analysing studies reporting outcomes for management strategies for penetrating atherosclerotic ulcers treatment, focusing on Type B, further seeking to analyse studies reporting their experiences of PAU patients with concomitant intramural haematoma. Our review highlights the ambiguity and controversy existing in the literature, comprising studies burdened by their inherent hindering limitations of their single-centre retrospective experiences. Endovascular therapy has come to the forefront of penetrating atherosclerotic ulcers management, often considered first line therapy. In the case of penetrating atherosclerotic ulcers alongside intramural haematoma, there have been reports of potential hybrid surgical approaches to management. Studies further show misdiagnosis of penetrating atherosclerotic ulcers in earlier data sets further complicates management. However, it is clear we must progress on the journey towards precision medicine, allowing delivery of optimum care to our patients.Copyright © The Author(s) 2021.

Author(s) Yap Z.J.; Sharif M.; Bashir M. (drmobashir@outlook.com)
Source Journal of Cardiac Surgery; Apr 2021; vol. 36 (no. 4); p. 1520-1530
AbstractBackground and Aim: Aortic aneurysms most commonly occur in the infra-renal and proximal thoracic regions. While generally asymptomatic, progressive aneurysmal dilation can become rapidly lethal when dissection or ruptures occurs, highlighting the need for more robust screening. Abdominal aortic aneurysm (AAA) is more prevalent compared to thoracic aortic aneurysm (TAA). The true incidence of TAA is underreported due to the absence of population screening and the silent nature of TAA. To achieve the optimum survival rate in aortic aneurysms, knowledge of natural course, genetic association, and surgical results are needed to be applied with adequate medical treatment and careful selection of patients for operation. The purpose of this paper is to provide a comprehensive review of the literature on natural history, immunology, and genetic differences between thoracic and AAAs. Method(s): The literature was collected from OVID, SCOPUS, and PubMed. Result(s): (1) AAA expands faster than TAA. AAA expands at approximately 0.3-0.45 cm annually, depending on various factors (advancing age, diameter of aorta, smoking etc.). TAA expands up to 0.3 cm annually in a non-bicuspid aortic valve patient. (2) An increase in Matrix metallopeptidase 1, 2, 9, 12, 14 led to degrading extracellular matrix of the aortic vessel wall. This significantly contributed to the pathogenesis in AAA, whereas overactive Transforming growth factor-beta played a major role in the pathogenesis of TAA. Conclusion(s): In the future, genetic testing may be the gold standard for tackling the geneticheterogeneity of aneurysms, therefore, identifying at-risk individuals developing TAA andAAA earlier.Copyright © 2021 Wiley Periodicals LLC

• Available at Journal of cardiac surgery from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M.; Hara H.; Wijns W.; Onuma Y.; Serruys P.W. (patrick.w.j.c.serruys@gmail.com); van Geuns R.-J.; Garg S.; Morice M.-C.; Davierwala P.M.; Kappetein A.P.; Holmes D.R.
AbstractAims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.]Copyright © 2021, The Author(s).

Author(s) Moore K.; Gordon A.; Thomas R.; Wood A.; White R.D.; Bailey D.M.; Lewis M.H.; Bashir M.; Williams I.M. (Ian.Williams5@wales.nhs.uk)
AbstractIntroduction: Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft. 

Author(s) Lopuszko; Patrick Tan, Sven Zhen Cian; Munir, Wahaj; Bashir, Mohamad
Source Journal of Cardiac Surgery; Jul 2021; vol. 36 (no. 7); p. 2496-2501
Language English
Publication Date Jul 2021
AbstractBackground: Aortic aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. Eight in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies, AA is thought to be subject to chronobiological patterns of varying incidence.Methods: We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology.Results: The incidence of AA is found to peak in the early morning (6-11 a.m.) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other cerebrovascular pathologies, such as myocardial infarcts, or cerebrovascular strokes.Conclusion: Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6-11 a.m.), and during colder months (December-January). This is more pronounced in patients with Marfan syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.

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Author(s) Tan ; El Santawy, Hazem; Abdelhaliem, Amr
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3352-3353
Database CINAHL

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Author(s) Mousavizadeh; Daliri, Mahdi; Aljadayel, Hadi Abo; Mohammed, Idhrees; Rezaei, Yousef; Bashir, Mohamad; Hosseini, Saeid
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3337-3351

• Available in full text at Journal of Cardiac Surgery from Wiley Online Library Medicine and Nursing Collection 2013​

Author(s) Serruys; Hara, Hironori; Garg, Scot; Kawashima, Hideyuki; Nørgaard, Bjarne L.; Dweck, Marc R.; Bax, Jeroen J.; Knuuti, Juhani; Nieman, Koen; Leipsic, Jonathon A.; Mushtaq, Saima; Andreini, Daniele; Onuma, Yoshinobu
Source Journal of the American College of Cardiology (JACC); Aug 2021; vol. 78 (no. 7); p. 713-736

Author(s) Idhrees; Hosseini, Saeid; Rezaei, Yousef; Mousavizadeh, Mostafa; Daliri, Mahdi; Aljadayel, Hadi Abo; Bashir, Mohamad
Source Journal of Cardiac Surgery; Aug 2021; vol. 36 (no. 8); p. 3011-3012
Publication Date Aug 2021

• Available at Journal of Cardiac Surgery from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) Bashir M. (drmbashir@mail.com); Mohammed I.; Mousavizadeh M.; Rezaei Y.; Hosseini S.
Source Journal of Cardiac Surgery; 2021

• Available at Journal of cardiac surgery from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) Serruys; Ono, Masafumi; Garg, Scot; Hara, Hironori; Kawashima, Hideyuki; Pompilio, Giulio; Andreini, Daniele; Holmes, David R.; Onuma, Yoshinobu; King III, Spencer B.
Source Journal of the American College of Cardiology (JACC); Jul 2021; vol. 78 (no. 4); p. 384-407
Publication Date Jul 2021

Author(s) Division of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea.; Liew Houng Bang; Eun Jung Jun; Ae-Young Her; Ju-Hyun Chung; Garg, Scot; Joo Myung Lee; Joon-Hyung Doh; Chang-Wook Nam; Bon-Kwon Koo; Qiang Tang
Source Cardiology Journal; Jul 2021; vol. 28 (no. 4); p. 615-622
AbstractAlthough drug-eluting stents (DES) have become the mainstay of percutaneous coronary intervention, late and very late stent thrombosis remains a concern. Drug-coated balloons (DCB) have the advantage of preserving the anti-restenotic benefits of DES while minimizing potential long-term safety concerns. Currently the two methods to ensure successful DCB treatment of a stenotic lesion are angiography or physiology-guided DCB application. This review will evaluate these two methods based on previous evidence and make suggestions on how to perform DCB treatment more efficiently and safely.

• Available at Cardiology Journal from EBSCO (MEDLINE Complete)

Author(s) Ono M.; Onuma Y.; Serruys P.W. (patrick.serruys@nuigalway.ie); Garg S.
Source European Heart Journal; Jul 2021; vol. 42 (no. 27); p. 2665-2669

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Author(s) Rimmer L.; Bashir M. (drmbashir@mail.com); Mellor S.; Harky A.; Gouda M.
Source Journal of Cardiac Surgery; Apr 2021; vol. 36 (no. 4); p. 1232-1240
AbstractBackground: Type B aortic dissection (TBAD) occurs seldomly, particularly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of type A aortic dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. This article collates knowledge so far on this rare event during pregnancy. Method(s): A comprehensive literature search was performed in PubMed, Scopus, Google Scholar, Embase, and Medline. Key search terms included "type B aortic dissection,""pregnancy," and corresponding synonyms. Non-English papers were excluded. Result(s): Risk factors for TBAD include aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a cesarean section before intervention is carried out unless certain indications are present. Conclusion(s): Due to a scarce number of cases across the decades, it is difficult to determine which management is optimal. The gold-standard management of TBAD has traditionally been the medical treatment for uncomplicated cases and open surgery for those needing urgent intervention, but with the advent of techniques, such as thoracic endovascular aortic repair, the management of these group of patients continues to develop.Copyright © 2021 Wiley Periodicals LLC

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Author(s) Lee M.M.Y.; Petrie M.C.; Simpson J.; Jackson C.E.; Corcoran D.S. et al.
Source Open Heart; Feb 2021; vol. 8 (no. 1)
Background Coronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS). Methods ACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated. 

• Available in full text at Open heart from Europe PubMed Central - Open Access

Author(s) Garg S.; Chichareon P.; Kogame N.; Takahashi K.; Modolo R. et al.
Source Catheterization and Cardiovascular Interventions; Dec 2020; vol. 96 (no. 7); p. 1369-1378
Language English
Publication Date Dec 2020
Objective: To investigate the impact of different anti-platelet strategies on outcomes after percutaneous coronary intervention (PCI) in patients with established cardiovascular disease (CVD). 

Author(s) Hui L.; Shin E.-S.; Jun E.J.; Kim T.-H.; Sohn C.-B.; Choi B.J.; Yuan S.L.; Kun L.; Zhi W.; Hao J.; Zhentao S.; Qiang T.; Bhak Y.; Garg S.
Source Yonsei Medical Journal; Dec 2020; vol. 61 (no. 12); p. 1004-1012
Language English
Publication Date Dec 2020
Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions. 

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Author(s) Takahashi K.; Kawashima H.; Ono M.; Hara H.; Wykrzykowska J.J. et al.
Source International Journal of Cardiology; Dec 2020; vol. 320 ; p. 27-34
Language English
Publication Date Dec 2020
Backgrounds: Data on optimal antiplatelet therapy in patients undergoing stenting of the proximal left anterior descending artery (LAD) are limited. Method(s): This is a post-hoc analysis of the GLOBAL LEADERS trial, a prospective, multi-center, randomized controlled trial, comparing the experimental strategy (1-month dual anti-platelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) with the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in relation to stenting of the proximal LAD. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction (MI) and key secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years. Result(s): Among 15,845 patients included in the analysis, 3823 (23.9%) patients underwent stenting of the proximal LAD, while 12,022 (75.2%) did not. In the proximal LAD stenting group, there was no significant difference in the risk of the primary endpoint between the two antiplatelet strategies (3.38% vs. 3.93%; hazard ratio [HR]:0.86; 95% CI:0.62-1.20; Pinteraction = 0.951). However, the risk of any MI (2.63% vs. 3.88%; HR:0.68; 95% CI:0.47-0.97; Pinteraction = 0.015) and any revascularization (7.84% vs. 9.94%; HR:0.78; 95% CI:0.63-0.97; Pinteraction = 0.058) was significantly lower in the experimental strategy group, while demonstrating a similar risk of BARC type 3 or 5 bleeding between the two antiplatelet strategies (1.93% vs. 1.99%; HR:0.98; 95% CI:0.62-1.54; Pinteraction = 0.981). Conclusion(s): The present study showed patients having stenting to the proximal LAD could potentially benefit from the experimental strategy with lower ischaemic events without a trade-off in major bleeding at two years.Copyright © 2020 Elsevier B.V.