Scot Garg - Academia.edu (original) (raw)

Papers by Scot Garg

Research paper thumbnail of First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015

Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with... more 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 revascula...

Research paper thumbnail of First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015

Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with... more 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 revascula...

Research paper thumbnail of Letter by Garg et al Regarding Article, "Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies

Circulation, Jan 16, 2016

Research paper thumbnail of Gender differences in plaque characteristics of culprit lesions in patients with ST elevation myocardial infarction

Heart and vessels, Jan 13, 2016

There is limited research on plaque characteristics of ST elevation myocardial infarction (STEMI)... more There is limited research on plaque characteristics of ST elevation myocardial infarction (STEMI) patients according to the gender and age. 280 Consecutive STEMI patients who underwent VH-IVUS imaging on culprit before percutaneous coronary intervention (PCI) were enrolled in this study. Women were significantly older than men (69.8 ± 10 vs. 55.9 ± 11.3, p < 0.001). After propensity matching, men had higher plaque burden (79.7 ± 7.8 vs. 73.7 ± 13.0 %, p = 0.010), more fibro-fatty tissue (12.8 ± 9.9 vs. 9.5 ± 6.8 %, p = 0.04) and less dense calcium than women (8.4 ± 5.8 vs. 12.3 ± 8.7 %, p = 0.007). Subgroups dividing by 50, 65, 75 years old, plaque burden was higher in elderly men aged 66-75 years compared to the young men aged less than 50 (75.5 ± 9.2 vs. 68.4 ± 10.1 %, p = 0.012). And middle aged men ranged 51-65 years showed significantly more plaque burden at minimal lumen area site than matched aged women (77.5 ± 8.0 vs. 69.0 ± 17.6 %, p = 0.012). Elderly women aged 66-75 ye...

Research paper thumbnail of Comparison of Paclitaxel-Coated Balloon Treatment and Plain Old Balloon Angioplasty for De Novo Coronary Lesions

Yonsei medical journal, 2016

This study compared the angiographic outcomes of paclitaxel-coated balloon (PCB) versus plain old... more 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. 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. 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<0.0...

Research paper thumbnail of How should I treat a patient with giant left main coronary artery aneurysm without associated stenosis?

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2016

Research paper thumbnail of Tarsem Lal Garg

Research paper thumbnail of Fractional Flow Reserve for Guiding PCI

New England Journal of Medicine

1. N Engl J Med. 2009 May 7;360(19):2024-5; author reply 2046-7. Fractional flow reserve for guid... more 1. N Engl J Med. 2009 May 7;360(19):2024-5; author reply 2046-7. Fractional flow reserve for guiding PCI. Nagajothi N, Arora R, Khosla S. Comment on: N Engl J Med. 2009 Jan 15;360(3):213-24. PMID: 19425191 [PubMed ...

Research paper thumbnail of Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom

Journal of the American College of Cardiology, Jan 28, 2015

Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite ... more 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 unadju...

Research paper thumbnail of Individualized Assessment for Percutaneous or Surgical Revascularization

Textbook of Interventional Cardiology, 2012

Research paper thumbnail of Prevalence and prognostic impact of right ventricular dilation in patients with moderate chronic heart failure. A cardiac-MRI study

European Journal of Heart Failure Supplements, 2008

gene polymorphisms (pms) resulted in an altered BAR function and regulations have been described.... more gene polymorphisms (pms) resulted in an altered BAR function and regulations have been described. Aims: To determine a possible usefulness of BAR1 (Ser49Gly; Arg389Gly) and BAR2 (Thr164Ile; Arg16Gly; Gln27Glu) genetic pms in the survival determination of patients with advanced HF referred for heart transplantation. Methods: The survival was assessed in 398 HF patients, with mean age 49±10 years, left ventricle dysfunction (systolic/diastolic diameter 62±13/73±11 mm; EF 21±8%), pulmonary hypertension (systolic pulmonary/mean wedge pressure 43±18/21±10 mmHg), reduced VO2max (13±4 mL/kg/min), elevated NTproBNP (4101±6372 pg/ml), hsCRP (8.3±23 mg/dl) and Aaronson score (7.69±0.9). The mean follow up period was 20±14 months. The end-point was defined as death or urgent heart transplantation. Statistical analysis was performed with the chi2, analysis of variance, the Kaplan-Meier methods. Results: Among assessed BAR1 pms, using the Kaplan-Meier methods we found that Ser49Gly pms influenced the survival rate significantly (Log-rank =6.7749, p =0.0338). The frequency of the Gly vs Ser vs Ser/Gly allele was 1.5%/78.5%/20% respectively. There were no significant differences in any clinical parameters in relation to BAR1 (Ser49Gly) pms. Among assessed BAR2 pms, using the Kaplan-Meier methods we found that Arg16Gly pms influenced the survival rate significantly (Log-rank =6.1289, p =0.0467). The frequency of the Arg vs Gly vs Arg/Gly allele was 20%/41%/39% respectively. There were no significant differences in any clinical parameter in relation to BAR2 (Arg16Gly) pms. Using the Kaplan-Meier and Cox proportional hazards method analyses we confirmed that the level of NTproBNP (Log-rank =15.3388, p =0.0005; HR=1.002, p=0.0008; respectively), Aaronson score (Log-rank = 13.8226, p = 0.0010; HR=0.629, p=0.0011), also hsCRP (Log-rank =2.0677, p=0.3556; HR=1.011, p<0.0001) were independent predictors of death. Conclusions: Among all assessed BAR pms, the genetic variants -BAR1 and also BAR2 genes may be associated with the survival rate. However their potential role in risk stratification needs to be further investigated. The classical risk factors NTproBNP, hsCRP levels and Aronson score proved their well known value in the assessment of the death risk in advanced HF.

Research paper thumbnail of Drug-eluting stents are safe

Clinical pharmacology and therapeutics, 2009

Research paper thumbnail of The FIREHAWK stent: will it achieve its potential?

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 20, 2013

Research paper thumbnail of DES the year in review: controversies

Minerva cardioangiologica, 2013

Drug-eluting stents (DES) have transformed interventional cardiology over the past decade. Whilst... more Drug-eluting stents (DES) have transformed interventional cardiology over the past decade. Whilst their efficacy has rarely been called into question, there have been concerns over the safety of the early devices, which has prompted the development of new coronary stents. Many of these new devices have entered clinical practice, however questions remain as to whether they offer the improvements in clinical outcomes that were originally anticipated. In addition, there is a debate whether the reported high efficacy of these devices enables percutaneous coronary intervention (PCI) to be performed in patient and lesion sub-groups previous entirely the domain of the cardiac surgeon. This review paper addresses these outstanding questions.

Research paper thumbnail of Biodegradable stents and non-biodegradable stents

Minerva cardioangiologica, 2009

The introduction of the coronary stent in 1986 was one of the most far-reaching changes in the pr... more The introduction of the coronary stent in 1986 was one of the most far-reaching changes in the practice of interventional cardiology since its inception in 1977. Despite all the benefits of the using a metallic drug eluting stent (DES), their limitations have generated interest towards biodegradable technology. These biodegradable stents, which are made of polymers or metal alloys with or without a drug coating, have the potential to scaffold the artery to allow natural healing to take place, and then biodegrade. The development of this technology has been slow, however several biodegradable stents have entered into clinical trials, with many more at the preclinical stage of development. Concurrently conventional metallic DES have tried to address their limitations; in particular they have sought to repair their damaged reputation following concerns over stent thrombosis. Accordingly, stents with a more biocompatible polymer and DES which are polymer-free have been developed, and ar...

Research paper thumbnail of How should I treat a tortuous calcified right coronary artery?

Research paper thumbnail of Percutaneous coronary interventions for all patients with complex coronary artery disease: triple vessel disease or left main coronary artery disease. Yes? No? Don't know?

Revista española de cardiología, 2009

Research paper thumbnail of Meditations on secondary revascularisation in the aftermath of the SYNTAX trial

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2009

Many patients will experience a return of symptoms after their initial revascularisation procedur... more Many patients will experience a return of symptoms after their initial revascularisation procedure necessitating secondary revascularisation (SR). The options for this second procedure are inherently influenced by the primary method adopted for revascularisation. Patients with single vessel disease are most suited to percutaneous coronary intervention (PCI) for both primary and secondary revascularisation. The arrival of drug eluting stents, and evidence from trials of highly select populations has threatened the place of coronary artery bypass grafting (CABG) as the preferred method of revascularisation in those with multivessel disease. At present, and without robust evidence, PCI is increasingly being used to treat highly complex lesions, such that many question whether CABG is still has a role in primary revascularisation. The consequence for SR is that currently it is increasingly likely to be in response to in-stent restenosis, whereby previously it was performed in those with...

Research paper thumbnail of Ten-year follow-up of the IGAKI-TAMAI stent. A posthumous tribute to the scientific work of Dr. Hideo Tamai

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 15, 2009

Research paper thumbnail of An update on drug-eluting stents

Current treatment options in cardiovascular medicine, 2013

Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Per... more Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Percutaneous coronary intervention has been shown to be an effective treatment for angina pectoris, although it does not provide any prognostic benefit in stable patients. Drug-eluting stents (DES) have revolutionised the practice of interventional cardiology by permitting the percutaneous treatment of increasingly complex coronary artery lesions, which historically would have only been treated with surgery. There have been concerns with their long-term safety; however, the most recent large meta-analysis appears to suggest that these concerns are no longer a pertinent issue with the newest generation of stents. Consequently, DES are being used in complex patients and lesion types, and clinical data and guideline recommendations support this. New stent designs are also continually being developed, with the aim to further improve the safety profile of these devices. It must, however, be kept...

Research paper thumbnail of First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015

Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with... more 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 revascula...

Research paper thumbnail of First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015

Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with... more 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 revascula...

Research paper thumbnail of Letter by Garg et al Regarding Article, "Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies

Circulation, Jan 16, 2016

Research paper thumbnail of Gender differences in plaque characteristics of culprit lesions in patients with ST elevation myocardial infarction

Heart and vessels, Jan 13, 2016

There is limited research on plaque characteristics of ST elevation myocardial infarction (STEMI)... more There is limited research on plaque characteristics of ST elevation myocardial infarction (STEMI) patients according to the gender and age. 280 Consecutive STEMI patients who underwent VH-IVUS imaging on culprit before percutaneous coronary intervention (PCI) were enrolled in this study. Women were significantly older than men (69.8 ± 10 vs. 55.9 ± 11.3, p < 0.001). After propensity matching, men had higher plaque burden (79.7 ± 7.8 vs. 73.7 ± 13.0 %, p = 0.010), more fibro-fatty tissue (12.8 ± 9.9 vs. 9.5 ± 6.8 %, p = 0.04) and less dense calcium than women (8.4 ± 5.8 vs. 12.3 ± 8.7 %, p = 0.007). Subgroups dividing by 50, 65, 75 years old, plaque burden was higher in elderly men aged 66-75 years compared to the young men aged less than 50 (75.5 ± 9.2 vs. 68.4 ± 10.1 %, p = 0.012). And middle aged men ranged 51-65 years showed significantly more plaque burden at minimal lumen area site than matched aged women (77.5 ± 8.0 vs. 69.0 ± 17.6 %, p = 0.012). Elderly women aged 66-75 ye...

Research paper thumbnail of Comparison of Paclitaxel-Coated Balloon Treatment and Plain Old Balloon Angioplasty for De Novo Coronary Lesions

Yonsei medical journal, 2016

This study compared the angiographic outcomes of paclitaxel-coated balloon (PCB) versus plain old... more 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. 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. 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<0.0...

Research paper thumbnail of How should I treat a patient with giant left main coronary artery aneurysm without associated stenosis?

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2016

Research paper thumbnail of Tarsem Lal Garg

Research paper thumbnail of Fractional Flow Reserve for Guiding PCI

New England Journal of Medicine

1. N Engl J Med. 2009 May 7;360(19):2024-5; author reply 2046-7. Fractional flow reserve for guid... more 1. N Engl J Med. 2009 May 7;360(19):2024-5; author reply 2046-7. Fractional flow reserve for guiding PCI. Nagajothi N, Arora R, Khosla S. Comment on: N Engl J Med. 2009 Jan 15;360(3):213-24. PMID: 19425191 [PubMed ...

Research paper thumbnail of Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom

Journal of the American College of Cardiology, Jan 28, 2015

Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite ... more 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 unadju...

Research paper thumbnail of Individualized Assessment for Percutaneous or Surgical Revascularization

Textbook of Interventional Cardiology, 2012

Research paper thumbnail of Prevalence and prognostic impact of right ventricular dilation in patients with moderate chronic heart failure. A cardiac-MRI study

European Journal of Heart Failure Supplements, 2008

gene polymorphisms (pms) resulted in an altered BAR function and regulations have been described.... more gene polymorphisms (pms) resulted in an altered BAR function and regulations have been described. Aims: To determine a possible usefulness of BAR1 (Ser49Gly; Arg389Gly) and BAR2 (Thr164Ile; Arg16Gly; Gln27Glu) genetic pms in the survival determination of patients with advanced HF referred for heart transplantation. Methods: The survival was assessed in 398 HF patients, with mean age 49±10 years, left ventricle dysfunction (systolic/diastolic diameter 62±13/73±11 mm; EF 21±8%), pulmonary hypertension (systolic pulmonary/mean wedge pressure 43±18/21±10 mmHg), reduced VO2max (13±4 mL/kg/min), elevated NTproBNP (4101±6372 pg/ml), hsCRP (8.3±23 mg/dl) and Aaronson score (7.69±0.9). The mean follow up period was 20±14 months. The end-point was defined as death or urgent heart transplantation. Statistical analysis was performed with the chi2, analysis of variance, the Kaplan-Meier methods. Results: Among assessed BAR1 pms, using the Kaplan-Meier methods we found that Ser49Gly pms influenced the survival rate significantly (Log-rank =6.7749, p =0.0338). The frequency of the Gly vs Ser vs Ser/Gly allele was 1.5%/78.5%/20% respectively. There were no significant differences in any clinical parameters in relation to BAR1 (Ser49Gly) pms. Among assessed BAR2 pms, using the Kaplan-Meier methods we found that Arg16Gly pms influenced the survival rate significantly (Log-rank =6.1289, p =0.0467). The frequency of the Arg vs Gly vs Arg/Gly allele was 20%/41%/39% respectively. There were no significant differences in any clinical parameter in relation to BAR2 (Arg16Gly) pms. Using the Kaplan-Meier and Cox proportional hazards method analyses we confirmed that the level of NTproBNP (Log-rank =15.3388, p =0.0005; HR=1.002, p=0.0008; respectively), Aaronson score (Log-rank = 13.8226, p = 0.0010; HR=0.629, p=0.0011), also hsCRP (Log-rank =2.0677, p=0.3556; HR=1.011, p<0.0001) were independent predictors of death. Conclusions: Among all assessed BAR pms, the genetic variants -BAR1 and also BAR2 genes may be associated with the survival rate. However their potential role in risk stratification needs to be further investigated. The classical risk factors NTproBNP, hsCRP levels and Aronson score proved their well known value in the assessment of the death risk in advanced HF.

Research paper thumbnail of Drug-eluting stents are safe

Clinical pharmacology and therapeutics, 2009

Research paper thumbnail of The FIREHAWK stent: will it achieve its potential?

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 20, 2013

Research paper thumbnail of DES the year in review: controversies

Minerva cardioangiologica, 2013

Drug-eluting stents (DES) have transformed interventional cardiology over the past decade. Whilst... more Drug-eluting stents (DES) have transformed interventional cardiology over the past decade. Whilst their efficacy has rarely been called into question, there have been concerns over the safety of the early devices, which has prompted the development of new coronary stents. Many of these new devices have entered clinical practice, however questions remain as to whether they offer the improvements in clinical outcomes that were originally anticipated. In addition, there is a debate whether the reported high efficacy of these devices enables percutaneous coronary intervention (PCI) to be performed in patient and lesion sub-groups previous entirely the domain of the cardiac surgeon. This review paper addresses these outstanding questions.

Research paper thumbnail of Biodegradable stents and non-biodegradable stents

Minerva cardioangiologica, 2009

The introduction of the coronary stent in 1986 was one of the most far-reaching changes in the pr... more The introduction of the coronary stent in 1986 was one of the most far-reaching changes in the practice of interventional cardiology since its inception in 1977. Despite all the benefits of the using a metallic drug eluting stent (DES), their limitations have generated interest towards biodegradable technology. These biodegradable stents, which are made of polymers or metal alloys with or without a drug coating, have the potential to scaffold the artery to allow natural healing to take place, and then biodegrade. The development of this technology has been slow, however several biodegradable stents have entered into clinical trials, with many more at the preclinical stage of development. Concurrently conventional metallic DES have tried to address their limitations; in particular they have sought to repair their damaged reputation following concerns over stent thrombosis. Accordingly, stents with a more biocompatible polymer and DES which are polymer-free have been developed, and ar...

Research paper thumbnail of How should I treat a tortuous calcified right coronary artery?

Research paper thumbnail of Percutaneous coronary interventions for all patients with complex coronary artery disease: triple vessel disease or left main coronary artery disease. Yes? No? Don't know?

Revista española de cardiología, 2009

Research paper thumbnail of Meditations on secondary revascularisation in the aftermath of the SYNTAX trial

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2009

Many patients will experience a return of symptoms after their initial revascularisation procedur... more Many patients will experience a return of symptoms after their initial revascularisation procedure necessitating secondary revascularisation (SR). The options for this second procedure are inherently influenced by the primary method adopted for revascularisation. Patients with single vessel disease are most suited to percutaneous coronary intervention (PCI) for both primary and secondary revascularisation. The arrival of drug eluting stents, and evidence from trials of highly select populations has threatened the place of coronary artery bypass grafting (CABG) as the preferred method of revascularisation in those with multivessel disease. At present, and without robust evidence, PCI is increasingly being used to treat highly complex lesions, such that many question whether CABG is still has a role in primary revascularisation. The consequence for SR is that currently it is increasingly likely to be in response to in-stent restenosis, whereby previously it was performed in those with...

Research paper thumbnail of Ten-year follow-up of the IGAKI-TAMAI stent. A posthumous tribute to the scientific work of Dr. Hideo Tamai

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 15, 2009

Research paper thumbnail of An update on drug-eluting stents

Current treatment options in cardiovascular medicine, 2013

Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Per... more Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Percutaneous coronary intervention has been shown to be an effective treatment for angina pectoris, although it does not provide any prognostic benefit in stable patients. Drug-eluting stents (DES) have revolutionised the practice of interventional cardiology by permitting the percutaneous treatment of increasingly complex coronary artery lesions, which historically would have only been treated with surgery. There have been concerns with their long-term safety; however, the most recent large meta-analysis appears to suggest that these concerns are no longer a pertinent issue with the newest generation of stents. Consequently, DES are being used in complex patients and lesion types, and clinical data and guideline recommendations support this. New stent designs are also continually being developed, with the aim to further improve the safety profile of these devices. It must, however, be kept...