​Author(s): Her A.-Y.; Shin E.-S.; Lee J.M.; Garg S.; Doh J.-H.; Nam C.-W.; Koo B.-K.
Source: International Journal of Cardiovascular Imaging; Apr 2018 ; p. 1-9
Publication Date: Apr 2018
Publication Type(s): Article In Press
Abstract:There is limited data on the efficacy of paclitaxel-coated balloon (PCB) compared to stents for de novo coronary lesions. The purpose of this study was to compare the efficacy of PCB treatment with stent implantation for de novo coronary lesions after successful plain old balloon angioplasty (POBA) guided by fractional flow reserve (FFR). In 200 patients scheduled for elective percutaneous coronary intervention (PCI) for de novo lesions, FFR was measured after POBA (POBA-FFR). If POBA-FFR was >= 0.75, patients were treated with PCB (PCB group, n = 78) or stent (Stent group, n = 73). If POBA-FFR was < 0.75, stent was implanted as planned (Reference group, n = 42). The primary endpoint was late lumen loss at 9 months and the secondary endpoint was adverse cardiac events (cardiac death, myocardial infarction, target lesion thrombosis, or repeat revascularization) at 12 months follow-up. There was no between-group differences in the POBA-FFR (0.87 +/- 0.05 in PCB, 0.89 +/- 0.06 in stent, p = 0.101). At 9 months, late lumen loss was significantly lower in the PCB group compared to the Stent group (0.05 +/- 0.33 vs. 0.59 +/- 0.76 mm, p < 0.001). Adverse cardiac events were not different between the PCB, Stent and Reference groups (2.6, 5.5, and 9.5% respectively; p = 0.430 for PCB vs. Stent group; p = 0.229 for the reference vs. both other groups). PCB treatment guided by POBA-FFR showed excellent 9 months angiographic and functional results, as well as comparable 12 months clinical outcomes, compared with stent implantation for de novo coronary lesions.Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature
Database: EMBASE

Author(s): Her A.-Y.; Kim Y.H.; Cho K.-I.; Garg S.; Shin E.-S.
Source: Yonsei Medical Journal; 2017; vol. 58 (no. 5); p. 954-958
Publication Date: 2017
Publication Type(s): Article
PubMedID: 28792138
Available  at Yonsei Medical Journal -  from EBSCO (MEDLINE Complete)
Available  at Yonsei Medical Journal -  from Europe PubMed Central - Open Access
Available  at Yonsei Medical Journal -  from nih.gov
Abstract:Purpose: There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosis found using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Materials and Methods: Patients who had >=3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; >=10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measured by using coronary computed tomography angiography with the scoring system. Results: A total of 261 patients were included in this study. Age (r=0.256, p<0.001), serum creatinine (r=0.139, p=0.030), mean of right arm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, p<0.001) showed significant correlation with CACS. The increased inter-arm SBP difference (>=6 mm Hg) was significantly associated with CACS >=300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12-4.22; p=0.022]. In multivariable analysis, the inter-arm SBP difference >=6 mm Hg was also significantly associated with CACS >=300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06-5.19; p=0.036). Conclusion: An increased inter-arm SBP difference (>=6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors. Copyright © Yonsei University College of Medicine 2017.
Database: EMBASE

Author(s): Her A.-Y.; Kim Y.H.; Cho K.-I.; Singh G.B.; Shin E.-S.; Garg S.; Koo B.-K.

Source: Yonsei Medical Journal; Jan 2017; vol. 58 (no. 1); p. 99-104

Publication Date: Jan 2017

Publication Type(s): Journal: Article

Available in full text at Yonsei Medical Journal 


Abstract:Purpose: This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. Materials and Methods: In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). Results: One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44-533.87, p=0.004). Conclusion: Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES. Copyright © Yonsei University College of Medicine 2017.
​
Database: EMBASE
 

Source: Journal of epidemiology and community health; Nov 2016; vol. 70 (no. 11); p. 1057-1064

Publication Type(s): Journal Article

Author(s): Cho, Kyoung Im; Shin, Eun-Seok; Ann, Soe Hee; Garg, Scot; Her, Ae-Young; Kim, Jeong Su; Han, Jun Hee; Jeong, Myung Ho; KAMIR Registry

Abstract:There are limited data on the influence of gender on risk factors and clinical outcomes in young patients with acute myocardial infarction (AMI).        

This prospective study stratified outcomes according to gender in patients of age ≤50 years with a diagnosis of AMI, and who were enrolled in the nationwide registry of the Korea Working Group of Myocardial Infarction. The end point was the incidence of major adverse cardiovascular events (MACEs) defined as the composite of cardiac death, recurrent myocardial infarction (MI), and repeat revascularisation at 30 days and 1 year after admission.

The registry enrolled 30 001 patients with AMI, of whom 5200 met the study inclusion criteria; 4805 patients were male and 395 were female. Current smoking was significantly higher in men, while hypertension and diabetes mellitus were significantly more common in women. Women underwent less coronary revascularisation, and were less likely to be on optimal medical therapy compared with men despite having a higher Killip class at presentation and higher risk angiographic findings.

Although women had higher rates of MACEs (3.8% vs 1.8%, p=0.018 at 30 days and 7.8% vs 4.7%, p=0.004 at 1-year follow-up) compared with men, female gender was not an independent predictor of MACEs after adjusting for propensity score.      
There were significant gender differences in the risk factors for coronary artery disease and the short-term and long-term clinical outcomes of young patients with AMI. Continued preventive strategies should be focused on gender-different risk factor reduction in these young patients.


Available in full text at Journal of Epidemiology and Community Health 

​Source: Journal of the Intensive Care Society; Nov 2016; vol. 17 (no. 4); p. 302-313

Publication Type(s): Journal: Article

Author(s): Crossingham I.R.; Nethercott D.R.; Columb M.O.

Abstract:Background: Measuring cardiac output is common in critical care and perioperative medicine. Different monitoring systems are often judged against others in comparative studies. There is no agreed standard or definition on which to base the conclusions of such studies. Objectives: To review comparative studies of cardiac output monitors using an agreement:tolerability index (ATI) as a measure of monitor precision. To compare the ATI of a monitor with the conclusions of authors regarding agreement and clinical utility. Design: Systematic review of comparative studies of cardiac output monitoring systems. The precision of each monitor was standardised against an ATI using a tolerability interval based on the normal range for cardiac index. The conclusions of each study were described as positive, neutral or negative, depending on whether authors reported the monitor to be acceptably precise and/or clinically useful. Comparison was made between the precision of a monitor and the likelihood of it being favoured by authors. Data sources: PubMed was searched up to March 2012. Eligibility criteria: Studies published in English that compared two or more methods for measuring cardiac output in adult humans. Results: A total of 213 papers documenting 409 separate comparisons of two methods of measuring cardiac output were included. ATIs for the different comparisons varied from 0.07 to 6.84 (where an ATI 2 unacceptable agreement). Thirty-one percent of authors defined their own terms for acceptable agreement. ATI was only moderately correlated with the conclusions of the authors (Spearman rho = 0.47, P < 0.0001). Conclusions: Authors should define what constitutes acceptable agreement a priori when reporting comparative studies of cardiac output monitors. The ATI and the tolerability interval may be a useful basis for helping define acceptable precision. 

Available in full text at Journal of the Intensive Care Society -  from Highwire Press

Citation: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jun 2016, vol. 87, no. 7, p. E248., 1522-726X (June 2016)
 
Author(s): Grundeken, Maik J, Wykrzykowska, Joanna J, Ishibashi, Yuki, Garg, Scot, de Vries, Ton, Garcia-Garcia, Hector M, Onuma, Yoshinobu, de Winter, Robbert J, Buszman, Pawel, Linke, Axel, Ischinger, Thomas, Klauss, Volker, Eberli, Franz, Corti, Roberto, Wijns, William, Morice, Marie-Claude, di Mario, Carlo, Meier, Bernhard, Jüni, Peter, Yazdani, Ashkan, Copt, Samuel, Windecker, Stephan, Serruys, Patrick W
 
Abstract: Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with worse procedural and clinical outcomes when compared with PCI of non-bifurcation lesions. Newer generation drug-eluting stents (DES) might improve long-term clinical outcomes after bifurcation PCI. The LEADERS trial was a 10-center, assessor-blind, non-inferiority, all-comers trial, randomizing 1,707 patients to treatment with a biolimus A9(TM) -eluting stent (BES) with an abluminal biodegradable polymer or a sirolimus-eluting stent (SES) with a durable polymer (ClinicalTrials.gov Identifier: NCT00389220). Five-year clinical outcomes were compared between patients with and without bifurcation lesions and between BES and SES in the bifurcation lesion subgroup. There were 497 (29%) patients with at least 1 bifurcation lesion (BES = 258; SES = 239). At 5-year follow-up, the composite endpoint of cardiac death, myocardial infarction (MI) and clinically-indicated (CI) target vessel revascularization (TVR) was observed more frequently in the bifurcation group (26.6% vs. 22.4%, P = 0.049). Within the bifurcation lesion subgroup, no differences were observed in (cardiac) death or MI rates between BES and SES. However, CI target lesion revascularization (TLR) (10.1% vs. 15.9%, P = 0.0495), and CI TVR (12.0% vs. 19.2%, P = 0.023) rates were significantly lower in the BES group. Definite/probable stent thrombosis (ST) rate was numerically lower in the BES group (3.1% vs. 5.9%, P = 0.15). Very late (>1 year) definite/probable ST rates trended to be lower with BES (0.4% vs. 3.1%, P = 0.057). In the treatment of bifurcation lesions, use of BES led to superior long-term efficacy compared with SES. Safety outcomes were comparable between BES and SES, with an observed trend toward a lower rate of very late definite/probable ST between 1 and 5 years with the BES. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
 
Source: Medline
 
Full Text:
Available from John Wiley and Sons in Catheterization and Cardiovascular Interventions

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​Citation: Yonsei medical journal, May 2016, vol. 57, no. 3, p. 606-613, 1976-2437 (May 2016)
 
Author(s): Her, Ae Young, Ann, Soe Hee, Singh, Gillian Balbir, Kim, Yong Hoon, Okamura, Takayuki, Garg, Scot, Koo, Bon Kwon, Shin, Eun Seok
 
Abstract: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.
 
Source: Medline
 
Full Text:
Available in Yonsei Medical Journal

​Citation: Yonsei Medical Journal, March 2016, vol./is. 57/2(337-341), 0513-5796 (March 2016)
 
Author(s): Her A.-Y., Ann S.H., Singh G.B., Kim Y.H., Yoo S.-Y., Garg S., Koo B.-K., Shin E.-S.
 
Language: English
 
Abstract: Purpose: This study compared the angiographic outcomes of paclitaxel-coated balloon (PCB) versus plain old balloon angioplasty (POBA) treatment for de novo coronary artery lesions. At present, there is no available data comparing the efficacy of PCB versus POBA for the treatment of de novo coronary lesions. Materials and Methods: This multicenter retrospective observational study enrolled patients with de novo coronary lesions with a reference vessel diameter between 2.5 mm and 3.0 mm and lesion length <24 mm who were successfully treated with PCB or POBA. Angiographic measurements and quantitative coronary analysis were performed before and after the procedure, and at 9 months follow-up. Results: A total of 72 patients (49 receiving PCB and 23 receiving POBA) were enrolled in this study. Late luminal loss was -0.12+/-0.30 mm in the PCB group and 0.25+/-0.50 mm in the POBA group (p<0.001). There was a higher percentage of binary restenosis (diameter stenosis >50%) in POBA, compared to PCB (30.4%, n=7 vs. 4.1%, n=2, p<0.001). Target vessel revascularization was higher in the POBA group (13.0%, n=3 vs. 0%,p=0.033). Conclusion: PCB treatment of de novo coronary lesions showed better 9-month angiographic outcomes than POBA treatment alone.
 
Publication Type: Journal: Article
 
Source: EMBASE
 
Full Text:
Available in Yonsei Medical Journal



 
 
 

Citation: Circulation, Feb 2016, vol. 133, no. 7, p. e406. (February 16, 2016)
 
Author(s): Garg, Scot, Anderson, Simon G, Woodward, Mark
 
Source: Medline
 
Full Text:
Available from Circulation

​

Citation: British journal of hospital medicine (London, England : 2005), Oct 2015, vol. 76, no. 10, p. 604-605, 1750-8460 (October 2, 2015)
 
Author(s): Mittal, R, Martin, R P
 
Source: Medline
 
Full Text:
Available from British Journal of Hospital Medicine 

Citation: Journal of the American College of Cardiology, Jul 2015, vol. 66, no. 4, p. 363-372 (July 28, 2015)
 
Author(s): Garg, Scot, Anderson, Simon G, Oldroyd, Keith, Berry, Colin, Emdin, Connor A, Peters, Sanne A E, West, Nick E J, Kelly, Damian, Balachandran, Kanarath, McDonald, John, Singh, Ravi, Devadathan, Sen, Redwood, Simon, Ludman, Peter F, Rahimi, Kazem, Woodward, Mark, British Cardiovascular Intervention Society, National Institute for Cardiovascular Outcomes Research
 
Abstract: Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p < 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients. PCI performed at centers without onsite surgical backup is not associated with any mortality hazard. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
 
Source: Medline
 
Full Text:
Available from ProQuest in Journal of the American College of Cardiology
​

Citation: EuroIntervention, May 2015, 1774-024X (May 2015)

Author(s): Nam J., Briggs A., Layland J., Oldroyd K., Curzen N., Sood A., Balachandran K., Das R., Junejo S., Eteiba H., Petrie M., Lindsay M., Watkins S., Mcentegart M., Corbett S., O'Rourke B., Lee M., O'Donnell A., McConnachie A., Henderson R., Berry C.

Abstract: Aims: To assess the cost-effectiveness of routine invasive management with functional assessment of coronary artery disease severity using fractional flow reserve (FFR) vs. standard invasive management without FFR in patients with a recent non-ST elevation myocardial infarction (NSTEMI). Methods and results: We undertook an economic evaluation nested within the randomised controlled trial along with literature input. The results of FAMOUS-NSTEMI have been recently published (Layland et al. Eur Heart J 2014). Part I of the economic analysis used raw, unadjusted resources costs and QALYs from FAMOUS RCT. Part II modelled the effect pathway of FFR by conditioning total costs and QALYs on the treatment decision, using statistical modelling. Results were then applied to treatment decision distributions following FFR or standard care management. FFR reduced revascularisation by PCI or CABG (OR 0.52; 95% CI: 0.28 - 0.94; p=0.022). Part I: FFR led to a mean cost savings (-350 [-1,366 to 672]). Likely drivers of cost savings are length of stay (-331 [-1,002 to 356]) and index year health events (-217 [-712 to 226]). However, low information size contributed to their large imprecision. Incremental QALYs were comparable (0.012 [-0.034 to 0.059]). Part II: uncertainty was reduced in both incremental cost (-204 [-797 to 398]) and incremental QALYs (-0.005 [-0.015 to 0.001]). Uncertainty in cost-effectiveness over common willingness-to-pay remained modest (~25%-30%). Conclusions: Early evidence suggests that compared with standard invasive management without FFR, routine adoption of FFR may be cost saving and comparable in QALYs. However, considerable uncertainty persists. We prescribe specific design considerations for a larger future Phase 3 trial, including increased information size, follow-up frequency and outcomes to aid modelling/lifetime extrapolation.

Conference Information: EuroPCR 2015 Paris France. Conference Start: 20150519 Conference End: 20150522

Publisher: EuroPCR

Publication Type: Journal: Conference Abstract

Source: EMBASE

Citation: International Journal of Cardiology, May 2015, vol./is. 187/1(111-115), 0167-5273;1874-1754 (06 May 2015)

Author(s): Campos C.M., Garcia-Garcia H.M., Van Klaveren D., Ishibashi Y., Cho Y.-K., Valgimigli M., Raber L., Jonker H., Onuma Y., Farooq V., Garg S., Windecker S., Morel M.-A., Steyerberg E.W., Serruys P.W.

Abstract: Objectives: To assess the clinical profile and long-term mortality in SYNTAX score II based strata of patients who received percutaneous coronary interventions (PCI) in contemporary randomized trials. Background: The SYNTAX score II was developed in the randomized, all-comers' SYNTAX trial population and is composed by 2 anatomical and 6 clinical variables. The interaction of these variables with the treatment provides individual long-term mortality predictions if a patient undergoes coronary artery bypass grafting (CABG) or PCI. Methods: Patient-level (n = 5433) data from 7 contemporary coronary drug-eluting stent (DES) trials were pooled. The mortality for CABG or PCI was estimated for every patient. The difference in mortality estimates for these two revascularization strategies was used to divide the patients into three groups of theoretical treatment recommendations: PCI, CABG or PCI/CABG (the latter means equipoise between CABG and PCI for long term mortality). Results: The three groups had marked differences in their baseline characteristics. According to the predicted risk differences, 5115 patients could be treated either by PCI or CABG, 271 should be treated only by PCI and, rarely, CABG (n = 47) was recommended. At 3-year follow-up, according to the SYNTAX score II recommendations, patients recommended for CABG had higher mortality compared to the PCI and PCI/CABG groups (17.4%; 6.1% and 5.3%, respectively; P < 0.01). Conclusions: The SYNTAX score II demonstrated capability to help in stratifying PCI procedures.

Publication Type: Journal: Article

Source: EMBASE