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Papers by Franz Neumann

Research paper thumbnail of Association between three-year mortality after transcatheter aortic valve implantation and paravalvular regurgitation graded by videodensitometry in comparison with visual grading

Clinical Research in Cardiology

Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiogr... more Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiograms is a new tool for objective grading of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Stratification with boundaries at 6% and 17% has been proposed to reflect “none/trace”, “mild” and “moderate or higher” PVR. Objective We sought to investigate the association of strata of VD-AR with 3-year mortality and to compare VD-AR with visual grading of angiograms. Methods We interrogated our database for patients undergoing transfemoral TAVI from 2008 to 2018. Vital status of the patients was obtained from population registers. To test differences in survival and estimate adjusted hazard ratios (HRs) we fitted Cox models. Results Our retrospective study included 699 patients with evaluable angiograms at completion of the TAVI procedure. Cumulative 3-year mortality was 35.0% in 261 (37.3%) patients with VD-AR < 6%, 33.9% in 325 (46.5%) patients with ...

Research paper thumbnail of Guía ESC/EACTS 2018 sobre revascularización miocárdica

Revista Espanola De Cardiologia, 2019

Autores/miembros del Grupo de Trabajo: Franz-Josef Neumann* (coordinador de la ESC) (Alemania), M... more Autores/miembros del Grupo de Trabajo: Franz-Josef Neumann* (coordinador de la ESC) (Alemania), Miguel Sousa-Uva*,◊ (coordinador de la EACTS) (Portugal), Anders Ahlsson◊ (Suecia), Fernando Alfonso (España), Adrian P. Banning (Reino Unido), Umberto Benedetto◊ (Reino Unido), Robert A. Byrne (Alemania), Jean-Philippe Collet (Francia), Volkmar Falk◊ (Alemania), Stuart J. Head◊ (Países Bajos), Peter Jüni (Canadá), Adnan Kastrati (Alemania), Akos Koller (Hungría), Steen D. Kristensen (Dinamarca), Josef Niebauer (Austria), Dimitrios J. Richter (Grecia), Petar M. Seferovic (Serbia), Dirk Sibbing (Alemania), Giulio G. Stefanini (Italia), Stephan Windecker (Suiza), Rashmi Yadav◊ (Reino Unido) y Michael O. Zembala◊ (Polonia)

Research paper thumbnail of Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion

Journal of Clinical Medicine, 2021

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy tim... more Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point fo...

Research paper thumbnail of Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes

New England Journal of Medicine, 2019

BACKGROUND The relative merits of ticagrelor as compared with prasugrel in patients with acute co... more BACKGROUND The relative merits of ticagrelor as compared with prasugrel in patients with acute coronary syndromes for whom invasive evaluation is planned are uncertain. METHODS In this multicenter, randomized, open-label trial, we randomly assigned patients who presented with acute coronary syndromes and for whom invasive evaluation was planned to receive either ticagrelor or prasugrel. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. A major secondary end point (the safety end point) was bleeding. RESULTS A total of 4018 patients underwent randomization. A primary-end point event occurred in 184 of 2012 patients (9.3%) in the ticagrelor group and in 137 of 2006 patients (6.9%) in the prasugrel group (hazard ratio, 1.36; 95% confidence interval [CI], 1.09 to 1.70; P = 0.006). The respective incidences of the individual components of the primary end point in the ticagrelor group and the prasugrel group were as follows: death, 4.5% and 3.7%; myocardial infarction, 4.8% and 3.0%; and stroke, 1.1% and 1.0%. Definite or probable stent thrombosis occurred in 1.3% of patients assigned to ticagrelor and 1.0% of patients assigned to prasugrel, and definite stent thrombosis occurred in 1.1% and 0.6%, respectively. Major bleeding (as defined by the Bleeding Academic Research Consortium scale) was observed in 5.4% of patients in the ticagrelor group and in 4.8% of patients in the prasugrel group (hazard ratio, 1.12; 95% CI, 0.83 to 1.51; P = 0.46). CONCLUSIONS Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups. (Funded by the German Center for Cardiovascular Research and Deutsches Herzzentrum München; ISAR-REACT 5 ClinicalTrials.gov number, NCT01944800.

Research paper thumbnail of Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST

Revista Española de Cardiología, 2017

Artículo especial Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes ... more Artículo especial Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) para el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST

Research paper thumbnail of Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation: From the ADAPT-DES Study

JACC. Cardiovascular interventions, Jan 8, 2018

The authors sought to investigate the association between P2Y reaction units (PRU) and the risk o... more The authors sought to investigate the association between P2Y reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y receptor inhibition; 2-ye...

Research paper thumbnail of Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention Through Ipsilateral Collateral Channels

JACC: Cardiovascular Interventions, 2017

Research paper thumbnail of Procedural and Clinical Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Journal of the American College of Cardiology, Jan 15, 2017

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS... more Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is being increasingly performed. From the Bicuspid AS TAVR multicenter registry, the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS were compared. Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity-score matching assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to VARC-2 criteria. Compared to patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p=0.006) and significantly lower device success rate (85.3% vs. 91.4%; p=0.002). Early generation devices (Sapien XT/CoreValve) were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS whereas new generation devices (Sapien 3/Lotus/Evolut R) were implanted in 226 and 225 patients with bicuspid and t...

Research paper thumbnail of Sex Differences in the Clinical Impact of High Platelet Reactivity After Percutaneous Coronary Intervention With Drug-Eluting Stents: Results From the ADAPT-DES Study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents)

Circulation. Cardiovascular interventions, Feb 1, 2017

Sex differences in the outcomes after percutaneous coronary intervention with drug-eluting stents... more Sex differences in the outcomes after percutaneous coronary intervention with drug-eluting stents and in the response to clopidogrel therapy have been reported; however, the differential risk of high platelet reactivity (HPR) on clopidogrel in women versus men is unknown. We compared 8448 patients enrolled in the ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) according to sex and the presence/absence of HPR on clopidogrel (defined as P2Y12 reactivity units >208). Study end points were definite and probable stent thrombosis (ST), clinically relevant bleeding, all-cause mortality, myocardial infarction, and major adverse cardiac events (comprising mortality, myocardial infarction, and target lesion revascularization). HPR was more common among women (1118/2163, 51.7%) than men (2491/6285, 39.6%). HPR was associated with a roughly double risk of 1-year ST in both women and men (women with versus without HPR: 1.4% versus 0.7%; hazard ratio [HR], 2....

Research paper thumbnail of Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents

International journal of cardiology, Jan 26, 2016

Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is... more Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadj...

Research paper thumbnail of Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

Journal of the American College of Cardiology, Sep 13, 2016

Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR)... more Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices. This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices. The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015. Of 301 patients, 199 patients (71.1%) were treated with early-generation devices (Sapien XT [Edwards Lifesciences Corporation, Irvine, California]: n = 87; CoreValve [Medtronic, Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices (Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean Society of Thoracic Surgeons score was 4.7 ± 5.2 without...

Research paper thumbnail of Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves

Journal of Cardiothoracic Surgery, 2016

Background: Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve impl... more Background: Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs. Methods: Between 01/2014 and 12/2014 three patients (two male, age: 71-80 y, log EUROScore I: 11.89-32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533-1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve. Results: Successful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occured regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5-2.5 cm 2 and pressure gradients of max/mean 14/6-36/16 mmHg. 30-day mortality was 0 %. At the latest follow-up of 90-530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported. Conclusions: In the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

Research paper thumbnail of Is There an Ideal Level of Platelet P2Y12-Receptor Inhibition in Patients Undergoing Percutaneous Coronary Intervention?: "Window" Analysis From the ADAPT-DES Study (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents)

JACC. Cardiovascular interventions, Jan 28, 2015

This study sought to determine whether there is an ideal level of platelet reactivity (PR) to opt... more This study sought to determine whether there is an ideal level of platelet reactivity (PR) to optimize safety and efficacy within the large multicenter ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents) study of 8,582 patients receiving successful drug-eluting stent implantation. Patients with high PR on clopidogrel have a greater incidence of adverse ischemic events after stent implantation, whereas low PR may increase bleeding. Due to limited sample size, previous studies have not been able to adjust for differences in baseline characteristics that may confound the relationship of PR and outcomes. In the ADAPT-DES study, routine platelet function testing (VerifyNow) was performed following clopidogrel loading. To characterize the independent association between PR and clinical events, patients were stratified into quintiles of P2Y12 reaction units (PRU). The PRU medians of the 5 quintiles were 57, 130, 187, 244, and 317 (most to least inhibited). There wa...

Research paper thumbnail of Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation: Two-Year Follow-Up From the ADAPT-DES Study

Circulation. Cardiovascular interventions, 2015

The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous cor... more The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes pr...

Research paper thumbnail of Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients: The ADAPT-DES Study

Circulation. Cardiovascular interventions, 2015

Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuat... more Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuating P2Y12 receptor inhibition. Previous observational and randomized trials report conflicting results regarding the clinical significance of this pharmacological interaction. We examined the interaction between concomitant administration of PPI and clopidogrel on platelet reactivity and clinical outcomes in the large-scale, prospective Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents study. On-treatment P2Y12 platelet reactivity testing was performed using the VerifyNow assay after clopidogrel loading and successful drug-eluting stent implantation at 11 sites in the United States and Germany. PPIs were prescribed at the discretion of treating physicians; patients were followed for 2 years. High platelet reactivity was defined as P2Y12 reactivity units >208. Of 8582 enrolled patients, 2697 (31.4%) were taking a PPI at the time of coronary intervention. After adjustment...

Research paper thumbnail of Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention

Journal of the American College of Cardiology, 2015

BACKGROUND The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) afte... more BACKGROUND The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. OBJECTIVES This study sought to characterize the determinants and consequences of PDB after PCI. METHODS The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. RESULTS Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p ¼ 0.009). CONCLUSIONS After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794) (

Research paper thumbnail of Rapamycin Effects Transcriptional Programs in Smooth Muscle Cells Controlling Proliferative and Inflammatory Properties

Molecular Pharmacology, 2004

Neointima formation, the leading cause of restenosis, is caused by proliferation of coronary arte... more Neointima formation, the leading cause of restenosis, is caused by proliferation of coronary artery smooth muscle cells (CASMCs) and is associated with infiltration by monocytes. Rapamycin inhibits neointima formation after stent implantation in humans. It reduces proliferation by its effects on mammalian target of rapamycin (mTOR) kinase. In this study, we investigated the expression of mTOR in human neointima and the effect of rapamycin on global transcriptional events controlling CASMC phenotype. In neointimal CASMCs, mTOR exhibited increased phosphorylation and was translocated to the nucleus compared with control. Comparative gene expression analysis of CASMCs treated with rapamycin (100 ng/ml) revealed downregulation of the transcription factor E2F-1, a key regulator of G 1 /S-phase entry, and of various retinoblastoma protein/E2F-1-regulated genes. In addition, we found changes in the expression of genes associated with replication, apoptosis, and This study was supported by a postdoctoral fellowship by the Deutsche Forschungsgemeinschaft Germany (ZO 104/1-1 and ZO 104/2-1 to D.Z.).

Research paper thumbnail of Platelet Reactivity and Clinical Outcomes After Coronary Artery Implantation of Drug-Eluting Stents in Subjects with Peripheral Arterial Disease: Analysis from the Adapt-Des Study

Journal of the American College of Cardiology, 2014

background: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovasc... more background: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovascular events following percutaneous coronary intervention. We assessed the relationship of platelet reactivity and clinical outcomes among subjects with and without PAD in the ADAPT-DES study. Methods: ADAPT-DES was a prospective, multicenter registry of patients who were successfully treated with coronary drug-eluting stents (DES). Platelet reactivity was assessed by VerifyNow point-of-care assays. A propensity-adjusted multivariable analysis was performed to determine the relationship between PAD, platelet reactivity, and subsequent adverse events (definite or probable stent thrombosis, all-cause mortality, myocardial infarction, and clinically relevant bleeding). results: Among 8,582 patients, 10.2% had a history of PAD. Mean VerifyNow P2Y12 reaction units (PRU) were not significantly different between PAD and no PAD groups (194 ± 102 vs. 187 ± 96, P=0.09). The frequency of high on-treatment platelet reactivity, defined as PRU>208, was also similar (45.4% vs. 42.4% respectively, P=0.09). Patients with PAD were older (mean age 66.9 vs. 63.2 years), and were more likely to have diabetes, previous MI, previous PCI or CABG, a history of renal insufficiency, and a history of cigarette smoking (all P<0.0001). In unadjusted analyses, patients with history of PAD had higher 1-year rates of all-cause mortality, MI, stent thrombosis, and major bleeding. In a propensity-adjusted multivariable model, a history of PAD was an independent predictor of 1-year mortality (

Research paper thumbnail of Statin treatment following coronary artery stenting and one-year survival

Journal of the American College of Cardiology, 2002

OBJECTIVES We assessed the influence of statin therapy given after the procedure on one-year surv... more OBJECTIVES We assessed the influence of statin therapy given after the procedure on one-year survival of patients treated with coronary artery stenting. BACKGROUND Coronary artery stenting is currently a common treatment option for patients with symptomatic coronary artery disease (CAD). Although several secondary prevention trials have demonstrated improved survival achieved with statin therapy in conservatively treated patients with CAD, it is not known whether this benefit can also be expected in patients undergoing percutaneous coronary interventions with intraluminal stenting. METHODS This study included 4,520 patients younger than 80 years who underwent coronary artery stenting and were discharged from the hospital in the period October 1995 through September 1999. We compared one-year mortality of 3,585 patients who received statins after stenting with that of 935 patients who did not. RESULTS The mortality rate at one year was 2.6% among patients who received statins and 5.6% among those who did not. Thus, statin therapy at discharge was associated with an unadjusted odds ratio (OR) of 0.46 (95% confidence interval [CI], 0.33 to 0.65), indicating a 54% reduction in the risk of death at one year. After adjusting for other covariates, the risk reduction associated with statin therapy was 49%, OR 0.51 (95% CI, 0.36 to 0.71). This reduction was observable in most of the subgroups of patients. CONCLUSIONS The results of this nonrandomized study show that statin therapy improves survival after coronary artery stenting independent of patient characteristics recorded on the day of the intervention.

Research paper thumbnail of Antiplatelet Effect of Ticlopidine After Coronary Stenting

Journal of the American College of Cardiology, 1997

Objectives. This study sought to investigate the contribution of ticlopidine to the inhibition of... more Objectives. This study sought to investigate the contribution of ticlopidine to the inhibition of platelet activation after coronary stent placement. Background. After coronary stenting, antiplatelet therapy with aspirin and ticlopidine improves stent patency compared with anticoagulation. However, the specific role of ticlopidine has not been elucidated. Methods. After successful coronary stent placement, we randomized 22 patients to receive ticlopidine and aspirin (ticlopidine group) and 25 to receive aspirin alone (aspirin group). Surface expression on platelets of the activated fibrinogen receptor and of P-selectin was assessed by flow cytometry. Results. In the aspirin group the percent of platelets with activated fibrinogen receptors increased between days 1 and 5 (p ‫؍‬ 0.001), whereas there were no substantial changes in the ticlopidine group. The percent of P-selectin-positive platelets did not change significantly in the aspirin group but decreased in the ticlopidine group (p ‫؍‬ 0.019). At day 5 after the intervention, the percent of platelets with activated fibrinogen receptors in the ticlopidine group was significantly lower (median [interquartile range]: 8.5 [3.1 to 17.8] vs. 18.1 [8.5 to 35.5], p ‫؍‬ 0.025), and there was a trend to fewer P-selectin-positive platelets than in the aspirin group (5.8 [3.4 to 9.5] vs. 8.8 [4.0 to 15.8], p ‫؍‬ 0.073). Conclusions. Combined antiplatelet therapy with ticlopidine plus aspirin is superior to treatment with aspirin alone in suppressing platelet activation after coronary stenting.

Research paper thumbnail of Association between three-year mortality after transcatheter aortic valve implantation and paravalvular regurgitation graded by videodensitometry in comparison with visual grading

Clinical Research in Cardiology

Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiogr... more Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiograms is a new tool for objective grading of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Stratification with boundaries at 6% and 17% has been proposed to reflect “none/trace”, “mild” and “moderate or higher” PVR. Objective We sought to investigate the association of strata of VD-AR with 3-year mortality and to compare VD-AR with visual grading of angiograms. Methods We interrogated our database for patients undergoing transfemoral TAVI from 2008 to 2018. Vital status of the patients was obtained from population registers. To test differences in survival and estimate adjusted hazard ratios (HRs) we fitted Cox models. Results Our retrospective study included 699 patients with evaluable angiograms at completion of the TAVI procedure. Cumulative 3-year mortality was 35.0% in 261 (37.3%) patients with VD-AR < 6%, 33.9% in 325 (46.5%) patients with ...

Research paper thumbnail of Guía ESC/EACTS 2018 sobre revascularización miocárdica

Revista Espanola De Cardiologia, 2019

Autores/miembros del Grupo de Trabajo: Franz-Josef Neumann* (coordinador de la ESC) (Alemania), M... more Autores/miembros del Grupo de Trabajo: Franz-Josef Neumann* (coordinador de la ESC) (Alemania), Miguel Sousa-Uva*,◊ (coordinador de la EACTS) (Portugal), Anders Ahlsson◊ (Suecia), Fernando Alfonso (España), Adrian P. Banning (Reino Unido), Umberto Benedetto◊ (Reino Unido), Robert A. Byrne (Alemania), Jean-Philippe Collet (Francia), Volkmar Falk◊ (Alemania), Stuart J. Head◊ (Países Bajos), Peter Jüni (Canadá), Adnan Kastrati (Alemania), Akos Koller (Hungría), Steen D. Kristensen (Dinamarca), Josef Niebauer (Austria), Dimitrios J. Richter (Grecia), Petar M. Seferovic (Serbia), Dirk Sibbing (Alemania), Giulio G. Stefanini (Italia), Stephan Windecker (Suiza), Rashmi Yadav◊ (Reino Unido) y Michael O. Zembala◊ (Polonia)

Research paper thumbnail of Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion

Journal of Clinical Medicine, 2021

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy tim... more Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point fo...

Research paper thumbnail of Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes

New England Journal of Medicine, 2019

BACKGROUND The relative merits of ticagrelor as compared with prasugrel in patients with acute co... more BACKGROUND The relative merits of ticagrelor as compared with prasugrel in patients with acute coronary syndromes for whom invasive evaluation is planned are uncertain. METHODS In this multicenter, randomized, open-label trial, we randomly assigned patients who presented with acute coronary syndromes and for whom invasive evaluation was planned to receive either ticagrelor or prasugrel. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. A major secondary end point (the safety end point) was bleeding. RESULTS A total of 4018 patients underwent randomization. A primary-end point event occurred in 184 of 2012 patients (9.3%) in the ticagrelor group and in 137 of 2006 patients (6.9%) in the prasugrel group (hazard ratio, 1.36; 95% confidence interval [CI], 1.09 to 1.70; P = 0.006). The respective incidences of the individual components of the primary end point in the ticagrelor group and the prasugrel group were as follows: death, 4.5% and 3.7%; myocardial infarction, 4.8% and 3.0%; and stroke, 1.1% and 1.0%. Definite or probable stent thrombosis occurred in 1.3% of patients assigned to ticagrelor and 1.0% of patients assigned to prasugrel, and definite stent thrombosis occurred in 1.1% and 0.6%, respectively. Major bleeding (as defined by the Bleeding Academic Research Consortium scale) was observed in 5.4% of patients in the ticagrelor group and in 4.8% of patients in the prasugrel group (hazard ratio, 1.12; 95% CI, 0.83 to 1.51; P = 0.46). CONCLUSIONS Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups. (Funded by the German Center for Cardiovascular Research and Deutsches Herzzentrum München; ISAR-REACT 5 ClinicalTrials.gov number, NCT01944800.

Research paper thumbnail of Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST

Revista Española de Cardiología, 2017

Artículo especial Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes ... more Artículo especial Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) para el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST

Research paper thumbnail of Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation: From the ADAPT-DES Study

JACC. Cardiovascular interventions, Jan 8, 2018

The authors sought to investigate the association between P2Y reaction units (PRU) and the risk o... more The authors sought to investigate the association between P2Y reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y receptor inhibition; 2-ye...

Research paper thumbnail of Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention Through Ipsilateral Collateral Channels

JACC: Cardiovascular Interventions, 2017

Research paper thumbnail of Procedural and Clinical Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Journal of the American College of Cardiology, Jan 15, 2017

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS... more Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is being increasingly performed. From the Bicuspid AS TAVR multicenter registry, the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS were compared. Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity-score matching assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to VARC-2 criteria. Compared to patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p=0.006) and significantly lower device success rate (85.3% vs. 91.4%; p=0.002). Early generation devices (Sapien XT/CoreValve) were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS whereas new generation devices (Sapien 3/Lotus/Evolut R) were implanted in 226 and 225 patients with bicuspid and t...

Research paper thumbnail of Sex Differences in the Clinical Impact of High Platelet Reactivity After Percutaneous Coronary Intervention With Drug-Eluting Stents: Results From the ADAPT-DES Study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents)

Circulation. Cardiovascular interventions, Feb 1, 2017

Sex differences in the outcomes after percutaneous coronary intervention with drug-eluting stents... more Sex differences in the outcomes after percutaneous coronary intervention with drug-eluting stents and in the response to clopidogrel therapy have been reported; however, the differential risk of high platelet reactivity (HPR) on clopidogrel in women versus men is unknown. We compared 8448 patients enrolled in the ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) according to sex and the presence/absence of HPR on clopidogrel (defined as P2Y12 reactivity units >208). Study end points were definite and probable stent thrombosis (ST), clinically relevant bleeding, all-cause mortality, myocardial infarction, and major adverse cardiac events (comprising mortality, myocardial infarction, and target lesion revascularization). HPR was more common among women (1118/2163, 51.7%) than men (2491/6285, 39.6%). HPR was associated with a roughly double risk of 1-year ST in both women and men (women with versus without HPR: 1.4% versus 0.7%; hazard ratio [HR], 2....

Research paper thumbnail of Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents

International journal of cardiology, Jan 26, 2016

Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is... more Percutaneous coronary intervention (PCI) of lesions with coronary arterial calcification (CAC) is common and has been historically associated with an increased risk of adverse events. Whether the association between target lesion calcification (CAC) and outcomes differ across drug-eluting stent generation or between patients with high vs. low residual platelet reactivity (PR) remains unknown. We assessed the association of CAC with adverse ischemic and bleeding events among patients undergoing contemporary PCI with drug-eluting stents (DES). We included all 8582 patients who underwent successful PCI with DES in the prospective ADAPT-DES study. Patients were grouped according to whether or not they had CAC. We used a multivariable logistic regression analysis to determine independent predictors of CAC. We assessed the 2-year risk of major adverse cardiac events (MACE: Death, myocardial infarction, or stent thrombosis) and bleeding by constructing Kaplan-Meier curves and fitting unadj...

Research paper thumbnail of Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

Journal of the American College of Cardiology, Sep 13, 2016

Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR)... more Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices. This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices. The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015. Of 301 patients, 199 patients (71.1%) were treated with early-generation devices (Sapien XT [Edwards Lifesciences Corporation, Irvine, California]: n = 87; CoreValve [Medtronic, Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices (Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean Society of Thoracic Surgeons score was 4.7 ± 5.2 without...

Research paper thumbnail of Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves

Journal of Cardiothoracic Surgery, 2016

Background: Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve impl... more Background: Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs. Methods: Between 01/2014 and 12/2014 three patients (two male, age: 71-80 y, log EUROScore I: 11.89-32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533-1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve. Results: Successful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occured regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5-2.5 cm 2 and pressure gradients of max/mean 14/6-36/16 mmHg. 30-day mortality was 0 %. At the latest follow-up of 90-530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported. Conclusions: In the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

Research paper thumbnail of Is There an Ideal Level of Platelet P2Y12-Receptor Inhibition in Patients Undergoing Percutaneous Coronary Intervention?: "Window" Analysis From the ADAPT-DES Study (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents)

JACC. Cardiovascular interventions, Jan 28, 2015

This study sought to determine whether there is an ideal level of platelet reactivity (PR) to opt... more This study sought to determine whether there is an ideal level of platelet reactivity (PR) to optimize safety and efficacy within the large multicenter ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents) study of 8,582 patients receiving successful drug-eluting stent implantation. Patients with high PR on clopidogrel have a greater incidence of adverse ischemic events after stent implantation, whereas low PR may increase bleeding. Due to limited sample size, previous studies have not been able to adjust for differences in baseline characteristics that may confound the relationship of PR and outcomes. In the ADAPT-DES study, routine platelet function testing (VerifyNow) was performed following clopidogrel loading. To characterize the independent association between PR and clinical events, patients were stratified into quintiles of P2Y12 reaction units (PRU). The PRU medians of the 5 quintiles were 57, 130, 187, 244, and 317 (most to least inhibited). There wa...

Research paper thumbnail of Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation: Two-Year Follow-Up From the ADAPT-DES Study

Circulation. Cardiovascular interventions, 2015

The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous cor... more The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes pr...

Research paper thumbnail of Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients: The ADAPT-DES Study

Circulation. Cardiovascular interventions, 2015

Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuat... more Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuating P2Y12 receptor inhibition. Previous observational and randomized trials report conflicting results regarding the clinical significance of this pharmacological interaction. We examined the interaction between concomitant administration of PPI and clopidogrel on platelet reactivity and clinical outcomes in the large-scale, prospective Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents study. On-treatment P2Y12 platelet reactivity testing was performed using the VerifyNow assay after clopidogrel loading and successful drug-eluting stent implantation at 11 sites in the United States and Germany. PPIs were prescribed at the discretion of treating physicians; patients were followed for 2 years. High platelet reactivity was defined as P2Y12 reactivity units >208. Of 8582 enrolled patients, 2697 (31.4%) were taking a PPI at the time of coronary intervention. After adjustment...

Research paper thumbnail of Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention

Journal of the American College of Cardiology, 2015

BACKGROUND The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) afte... more BACKGROUND The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. OBJECTIVES This study sought to characterize the determinants and consequences of PDB after PCI. METHODS The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. RESULTS Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p ¼ 0.009). CONCLUSIONS After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794) (

Research paper thumbnail of Rapamycin Effects Transcriptional Programs in Smooth Muscle Cells Controlling Proliferative and Inflammatory Properties

Molecular Pharmacology, 2004

Neointima formation, the leading cause of restenosis, is caused by proliferation of coronary arte... more Neointima formation, the leading cause of restenosis, is caused by proliferation of coronary artery smooth muscle cells (CASMCs) and is associated with infiltration by monocytes. Rapamycin inhibits neointima formation after stent implantation in humans. It reduces proliferation by its effects on mammalian target of rapamycin (mTOR) kinase. In this study, we investigated the expression of mTOR in human neointima and the effect of rapamycin on global transcriptional events controlling CASMC phenotype. In neointimal CASMCs, mTOR exhibited increased phosphorylation and was translocated to the nucleus compared with control. Comparative gene expression analysis of CASMCs treated with rapamycin (100 ng/ml) revealed downregulation of the transcription factor E2F-1, a key regulator of G 1 /S-phase entry, and of various retinoblastoma protein/E2F-1-regulated genes. In addition, we found changes in the expression of genes associated with replication, apoptosis, and This study was supported by a postdoctoral fellowship by the Deutsche Forschungsgemeinschaft Germany (ZO 104/1-1 and ZO 104/2-1 to D.Z.).

Research paper thumbnail of Platelet Reactivity and Clinical Outcomes After Coronary Artery Implantation of Drug-Eluting Stents in Subjects with Peripheral Arterial Disease: Analysis from the Adapt-Des Study

Journal of the American College of Cardiology, 2014

background: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovasc... more background: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovascular events following percutaneous coronary intervention. We assessed the relationship of platelet reactivity and clinical outcomes among subjects with and without PAD in the ADAPT-DES study. Methods: ADAPT-DES was a prospective, multicenter registry of patients who were successfully treated with coronary drug-eluting stents (DES). Platelet reactivity was assessed by VerifyNow point-of-care assays. A propensity-adjusted multivariable analysis was performed to determine the relationship between PAD, platelet reactivity, and subsequent adverse events (definite or probable stent thrombosis, all-cause mortality, myocardial infarction, and clinically relevant bleeding). results: Among 8,582 patients, 10.2% had a history of PAD. Mean VerifyNow P2Y12 reaction units (PRU) were not significantly different between PAD and no PAD groups (194 ± 102 vs. 187 ± 96, P=0.09). The frequency of high on-treatment platelet reactivity, defined as PRU>208, was also similar (45.4% vs. 42.4% respectively, P=0.09). Patients with PAD were older (mean age 66.9 vs. 63.2 years), and were more likely to have diabetes, previous MI, previous PCI or CABG, a history of renal insufficiency, and a history of cigarette smoking (all P<0.0001). In unadjusted analyses, patients with history of PAD had higher 1-year rates of all-cause mortality, MI, stent thrombosis, and major bleeding. In a propensity-adjusted multivariable model, a history of PAD was an independent predictor of 1-year mortality (

Research paper thumbnail of Statin treatment following coronary artery stenting and one-year survival

Journal of the American College of Cardiology, 2002

OBJECTIVES We assessed the influence of statin therapy given after the procedure on one-year surv... more OBJECTIVES We assessed the influence of statin therapy given after the procedure on one-year survival of patients treated with coronary artery stenting. BACKGROUND Coronary artery stenting is currently a common treatment option for patients with symptomatic coronary artery disease (CAD). Although several secondary prevention trials have demonstrated improved survival achieved with statin therapy in conservatively treated patients with CAD, it is not known whether this benefit can also be expected in patients undergoing percutaneous coronary interventions with intraluminal stenting. METHODS This study included 4,520 patients younger than 80 years who underwent coronary artery stenting and were discharged from the hospital in the period October 1995 through September 1999. We compared one-year mortality of 3,585 patients who received statins after stenting with that of 935 patients who did not. RESULTS The mortality rate at one year was 2.6% among patients who received statins and 5.6% among those who did not. Thus, statin therapy at discharge was associated with an unadjusted odds ratio (OR) of 0.46 (95% confidence interval [CI], 0.33 to 0.65), indicating a 54% reduction in the risk of death at one year. After adjusting for other covariates, the risk reduction associated with statin therapy was 49%, OR 0.51 (95% CI, 0.36 to 0.71). This reduction was observable in most of the subgroups of patients. CONCLUSIONS The results of this nonrandomized study show that statin therapy improves survival after coronary artery stenting independent of patient characteristics recorded on the day of the intervention.

Research paper thumbnail of Antiplatelet Effect of Ticlopidine After Coronary Stenting

Journal of the American College of Cardiology, 1997

Objectives. This study sought to investigate the contribution of ticlopidine to the inhibition of... more Objectives. This study sought to investigate the contribution of ticlopidine to the inhibition of platelet activation after coronary stent placement. Background. After coronary stenting, antiplatelet therapy with aspirin and ticlopidine improves stent patency compared with anticoagulation. However, the specific role of ticlopidine has not been elucidated. Methods. After successful coronary stent placement, we randomized 22 patients to receive ticlopidine and aspirin (ticlopidine group) and 25 to receive aspirin alone (aspirin group). Surface expression on platelets of the activated fibrinogen receptor and of P-selectin was assessed by flow cytometry. Results. In the aspirin group the percent of platelets with activated fibrinogen receptors increased between days 1 and 5 (p ‫؍‬ 0.001), whereas there were no substantial changes in the ticlopidine group. The percent of P-selectin-positive platelets did not change significantly in the aspirin group but decreased in the ticlopidine group (p ‫؍‬ 0.019). At day 5 after the intervention, the percent of platelets with activated fibrinogen receptors in the ticlopidine group was significantly lower (median [interquartile range]: 8.5 [3.1 to 17.8] vs. 18.1 [8.5 to 35.5], p ‫؍‬ 0.025), and there was a trend to fewer P-selectin-positive platelets than in the aspirin group (5.8 [3.4 to 9.5] vs. 8.8 [4.0 to 15.8], p ‫؍‬ 0.073). Conclusions. Combined antiplatelet therapy with ticlopidine plus aspirin is superior to treatment with aspirin alone in suppressing platelet activation after coronary stenting.