Gregg W Stone

St. Michael's Hospital, Toronto, Ontario, Canada

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Publications (988)7094.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To assess the relationship of femoral vascular closure device (VCD) use to bleeding and ischemic events in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) via different anticoagulation strategies.Background: It is unknown whether femoral VCD reduce major bleeding after primary PCI for STEMI using bivalirudin anticoagulation.Methods: We compared VCD-treated patients with propensity-matched controls in the HORIZONS-AMI trial with respect to net adverse clinical events (NACE), defined as the composite of major bleeding unrelated to coronary artery bypass graft surgery (CABG) and major adverse cardiac events (comprised of death, reinfarction, ischemia-driven target vessel revascularization and stroke), at 30 days and 1 year.Results: Among 3,602 patients enrolled in HORIZONS-AMI, 2,948 underwent primary PCI via femoral arterial access and 896 (30%) received VCDs, of whom 642 were included in our model along with 642 propensity-matched controls. At 30 days, VCD-treated patients had significantly less NACE (6.7% vs. 10.8%, HR: 0.61, 95% CI: 0.42-0.89, p=0.009), driven by a lower rate of non-CABG related major bleeding (5.0% vs. 8.1%, HR: 0.61, 95% CI: 0.39-0.94, p=0.02). Bleeding reduction was maintained at one year and consistent in magnitude regardless of randomization to bivalirudin or unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (p for interaction = 0.84).Conclusion: In patients undergoing transfemoral primary PCI for STEMI, VCD use was associated with significantly lower non-CABG major bleeding irrespective of anticoagulation strategy. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 09/2014; · 2.51 Impact Factor
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    ABSTRACT: Different definitions of periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) have been provided, but their impact on prognosis remains to be determined.
    Journal of interventional cardiology. 08/2014;
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    ABSTRACT: Aims: To determine whether multivessel (MV) percutaneous coronary intervention (PCI) performed in one procedure improves outcomes when compared to single-vessel (SV) PCI for the culprit lesion(s) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods and results: We utilised the Acute Catheterisation and Urgent Intervention Triage StrategY (ACUITY) study database to analyse the outcomes of 2,255 patients with MV disease who underwent SV PCI compared to 609 patients who underwent MV PCI in the setting of NSTE-ACS. The primary endpoint was the one-year rate of major adverse cardiac events (MACE): death from any cause, myocardial infarction (MI), or ischaemia-driven revascularisation. At one year, patients undergoing MV PCI compared to SV PCI had similar rates of MACE (24.1% vs. 21.7%, respectively, p=0.11). However, death/MI was significantly higher in the MV PCI group (15.7% vs. 12.6%, p=0.05), primarily driven by higher rates of periprocedural non-Q-wave MI. Rates of death, ischaemia-driven revascularisation, stent thrombosis, acute renal failure and major bleeding were similar in both groups. By multivariable analysis with propensity score adjustment, MV PCI was not an independent predictor of one-year MACE (HR=1.22; 95% confidence interval [CI]: 0.96, 1.55; p=0.12) or death/MI (HR=1.28; 95% CI: 0.95, 1.74; p=0.15). Conclusions: In patients with NSTE-ACS and MV disease, MV PCI does not appear to provide a clear clinical benefit over SV PCI. Randomised clinical trials specifically addressing these two strategies in this population, with attention to quality of life and symptom relief, are warranted.
    08/2014;
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    ABSTRACT: Compared with bare metal stents (BMS), first-generation drug-eluting stents (DES) have significantly reduced the risk of ischemia-driven target vessel revascularization, but have been associated with an increased risk of very late (beyond 1 year) stent thrombosis. Second-generation DES have been developed using different platforms, alternative drugs, and either more biocompatible durable polymers or bioabsorbable polymers. In this review, we will analyze whether the improved technology of this new class of devices has improved their safety profile.
    Current opinion in cardiology. 08/2014;
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    ABSTRACT: Background The results of SYNTAX trial have been reported based on “corelab” calculated SS (cSS). It has been shown that reproducibility of SS is better among the core laboratory technicians than interventional cardiologists. Thus, the prognostic value and clinical implication of the “site” SYNTAX SS (sSS) remain unknown. Objectives The study sought to evaluate the prognostic value and clinical implication of the sSS after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in the randomized SYNTAX trial. Methods The sSS was calculated by the site investigators before randomization in the SYNTAX trial. New tertiles based on the sSS were defined with low (0 to 19), intermediate (20 to 27), and high (≥28) scores. The clinical endpoints were compared between PCI and CABG by Kaplan-Meier estimates, log-rank comparison, and Cox regression analyses using the new tertiles. The sSS-based SS II was calculated and its predictive performance was evaluated. Results The mean difference in cSS and sSS is 3.8 ± 11.2, with a mean absolute difference of 8.9 ± 7.8. In the overall cohort, using sSS there was a higher incidence of major adverse cardiac and cerebrovascular events (MACCE) at 5-year follow-up in the PCI group for low (31.9% vs. 24.5%; p = 0.054), intermediate (39.5% vs. 29.5%; p = 0.019), and high (43.0% vs. 31.4%; p = 0.003) tertiles, compared with the CABG group. Similarly, in the 3-vessel disease subgroup, 5-year MACCE rates were higher in PCI group in all tertiles. Conversely, in the left main subgroup, MACCE rates were similar for PCI and CABG groups in all tertiles. The sSS-based SS II (c-index: 0.736) had predictive performance similar to the cSS-based SS II (c-index: 0.744), with net reclassification index of –0.0062 (p = 0.79). Conclusions Appropriate training and unbiased assessment are needed when using SS in clinical decision making. sSS and tertiles based on sSS showed poor discrimination among low, intermediate, and high-risk groups. However, combining clinical factors with sSS retained the predictive performance of SS II. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972)
    Journal of the American College of Cardiology 08/2014; 64(5):423–432. · 14.09 Impact Factor
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    ABSTRACT: Background Studies have shown sex-based disparities in STEMI management and prognosis. We sought to compare women and men undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in a large, prospective, contemporary context.Methods The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial randomized 3602 patients (23.4% women and 76.6% men) with STEMI presenting within 12 hours of onset of symptoms to bivalirudin or heparin plus glycoprotein IIb/IIIa inhibitors and to PCI with drug-eluting or bare metal stents.ResultsCompared with men, women presented later after symptom onset and were more often treated with medical management alone (6.9% versus 4.7%; P=0.01). Women had significantly higher rates of 3-year major adverse cardiac events (MACE) and major bleeding. After adjusting for baseline differences, female sex remained an independent predictor of major bleeding (hazard ratio [HR] 1.81, 95% confidence interval [CI] 1.41 – 2.33; P<0.0001) but not of MACE (HR 1.09; 95% CI 0.91 – 1.32; P=0.35).Conclusions This study found that women with STEMI are at increased risk of bleeding compared to men. While female sex may not directly contribute to increased risk of MACE, it is, however, associated with the presence of comorbidities that increase the risk of ischemic events long-term. Further dedicated studies are needed to confirm these findings and to assess strategies to optimize both the initial emergent treatment and improve long-term outcomes in this high-risk subset. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 08/2014; · 2.51 Impact Factor
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    ABSTRACT: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia "bursts" (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR).
    European heart journal. Acute cardiovascular care. 07/2014;
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    ABSTRACT: Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and 4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25, 95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.
    07/2014;
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    ABSTRACT: Rapid reperfusion with primary percutaneous coronary intervention improves survival in patients with ST-segment elevation myocardial infarction. Preprocedural cardiopulmonary instability and adverse events (IAE) may delay reperfusion time and worsen prognosis. The aim of this study was to evaluate the relation between preprocedural cardiopulmonary IAE, door-to-balloon time (DBT), and outcomes in the Harmonizing Outcomes With Revascularization and Stents in AMI (HORIZONS-AMI) trial. Preprocedural cardiopulmonary IAE included sustained ventricular or supraventricular tachycardia or fibrillation requiring cardioversion or defibrillation, heart block or bradycardia requiring pacemaker implantation, severe hypotension requiring vasopressors or intra-aortic balloon counterpulsation, respiratory failure requiring mechanical ventilation, and cardiopulmonary resuscitation. Three-year outcomes of patients with and without IAE according to DBT were compared. Among 3,602 patients, 159 (4.4%) had ≥1 IAE. DBT did not differ significantly in patients with and without IAE; however, patients with IAE were less likely to have Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after percutaneous coronary intervention. Mortality at 3 years was significantly higher in patients with versus those without IAE (17.0% vs 6.3%, p <0.0001), and IAE was an independent predictor of mortality, whereas DBT was not. However, a significant interaction was present such that 3-year mortality was reduced in patients with DBT <99 minutes (the median) versus ≥99 minutes to a greater extent in patients with IAE (9.9% vs 20.7%, hazard ratio 0.43, 95% confidence interval 0.16 to 1.16) compared with those without IAE (5.0% vs 7.2%, hazard ratio 0.69, 95% confidence interval 0.50 to 0.95) (p for interaction = 0.004). In conclusion, IAE before PCI is an independent predictor of death and identifies a high-risk group in whom faster reperfusion may be particularly important to improve survival.
    The American journal of cardiology. 07/2014;
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    ABSTRACT: Objectives: Contrast-induced acute kidney injury (CI-AKI) may occur after percutaneous coronary intervention (PCI). We sought to evaluate patients with ST-elevation myocardial infarction (STEMI) undergoing emergency PCI and evaluated their risk for CI-AKI.Methods: Serum biomarkers were measured in patients who provided specific written informed consent for blood withdrawal at baseline, discharge, and 30-day and 1-year follow-up.Results: Of the 390 patients enrolled in the HORIZONS-AMI biomarker substudy, 56 (14.3%) developed AKI. In the AKI group, the levels of B-type natriuretic peptide (BNP) were consistently higher than in the no-AKI group at baseline (p=0.0327), hospital discharge (p=0.0002), 30-day follow-up (p=0.0193), and 1-year follow-up (p=0.031). At hospital discharge the AKI group had elevated biomarkers compared to the no-AKI group: D-dimer (p= 0.0066), C-reactive protein (p=0.0468), endothelial cell-selective adhesion molecule (p=0.0169), adiponectin (p=0.0346), and von Willebrand factor (p=0.0168); there was also a trend towards higher cystatin C (p=0.0585) in the AKI group. Similar correlations between biomarker panel increase and the development of CI-AKI were consistent at baseline, 30-day, and 1-year follow-up. Chemokine (C-C motif) ligand 23 showed an opposite pattern with an increase at all time points in the no-AKI compared to the AKI group.Conclusions: The risk of CI-AKI after primary PCI for STEMI may be associated with hemostatic imbalances, activation of procoagulants, decreased endogenous anticoagulants, enhanced inflammation, platelet activation, or decreased fibrinolytic activity. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 07/2014; · 2.51 Impact Factor
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    ABSTRACT: In patients with acute ST-segment elevation myocardial infarction, early, successful, and durable reperfusion therapy optimizes the likelihood of favorable outcomes. Fibrinolysis and primary percutaneous coronary intervention improve survival compared to no reperfusion therapy in large part by reducing infarct size (IS) and preserving left ventricular ejection fraction. There is direct correlation between IS and clinical outcomes. In this article, we will review some of the more promising pharmacological agents geared toward reduction in IS, discuss the major pathways that can lead to this desirable outcome, and evaluate the results of clinical trials performed with these and other compounds.
    Journal of Cardiovascular Pharmacology and Therapeutics 07/2014; · 3.07 Impact Factor
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    ABSTRACT: Concerns have emerged regarding a higher risk of stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Therefore, we performed a meta-analysis based on individual patient data to evaluate long-term safety and effectiveness of paclitaxel-eluting stent (PES) as compared to bare metal stents (BMS) in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. We examined all completed randomized trials on PES for STEMI. Individual patient data were obtained from six trials. We performed survival analyses with the use of Cox-regression analysis stratified according to trial. Kaplan-Meier survival curves are presented with event rates reported as estimated probabilities. A subsequent landmark analysis was performed for patients who were event-free at 1-year follow-up in order to define outcome in terms of early (≤1 year) and late (>1 year) events. A total of six trials were finally included in the meta-analysis with 4435 patients, 2875 (64.8 %) assigned to PES and 1560 (35.2 %) to BMS. No significant differences in baseline characteristics were observed between the two groups. However, a significantly higher percentage of patients in the DES group were on dual antiplatelet therapy during 3-year follow-up, as compared to BMS. At long-term follow-up (1,095 [1,090-1,155] days), no significant difference between PES and BMS was observed in mortality (9.2 vs 11.9 %, respectively, HR [95 % CI] = 0.84 [0.67, 1.06], p = 0.15, pheterogeneity = 0.59), reinfarction (8.8 vs 7 %, respectively; HR [95 % CI] = 1.10 [0.84, 1.44], p = 0.51, pheterogeneity = 0.32), stent thrombosis (6.7 vs 4.0 % respectively, HR [95 % CI] = 1.13 [0.82, 1.55], p = 0.45, pheterogeneity = 0.99) and TVR (11.9 vs 20.0 %; HR [95 % CI] = 0.64 [0.54, 0.77], p < 0.0001, pheterogeneity = 0.25). Landmark analysis showed that PES was associated with a significantly higher rate of very late reinfarction (>1 year) (5.6 vs 3.9 %, HR [95 % CI] = 1.61 [1.05-2.47], p = 0.03, pheterogeneity = 0.51], very late ST (2.9 vs 1.1 %, HR [95 % CI] = 1.88 [1.00-3.54], p = 0.05, pheterogeneity = 0.94]. The present pooled patient-level meta-analysis demonstrates that among STEMI patients undergoing primary PCI, PES compared to BMS is associated with a significant reduction in TVR at long-term follow-up. Although there were no differences in cumulative mortality, reinfarction or stent thrombosis, the incidence of very late reinfarction and stent thrombosis was increased with PES.
    Journal of Thrombosis and Thrombolysis 06/2014; · 1.99 Impact Factor
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    ABSTRACT: Reinfarction after primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction has negative consequences. Little is known about reinfarction after drug-eluting stents and bivalirudin anticoagulation. We, therefore, sought to determine the incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention in the contemporary era.
    Circulation Cardiovascular Interventions 06/2014; · 6.54 Impact Factor
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    ABSTRACT: Objectives: To report 1- and 2-year clinical outcomes of patients receiving platinum chromium everolimus-eluting stents (PtCr-EES) in the prospective, single-arm PLATINUM small vessel (SV) and long lesion (LL) studies. Background: Small vessel diameter and long lesion length are independently associated with increased risk of adverse cardiac events after drug-eluting stent implantation. Methods: The PLATINUM SV study enrolled 94 patients with coronary artery lesions in vessels ≥2.25 mm to <2.50 mm in diameter and ≤28 mm in length. The PLATINUM LL study enrolled 102 patients with lesions >24 to ≤34 mm long in vessels ≥2.50 to ≤4.25 mm in diameter. The primary endpoint for both studies was target lesion failure (TLF) at 1 year compared to a prespecified performance goal based on outcomes with the TAXUS Express paclitaxel-eluting stent in small vessels and long lesions. Results: One-year TLF rates with the PtCr-EES were significantly (P<0.001) lower than the predetermined performance goals: 2.4% vs 21.1% in the SV cohort and 3.2% vs 19.4% in the LL cohort. Cumulative rates of TLF to 2 years were 4.7% in the SV cohort and 8.8% in the LL cohort. No myocardial infarction (MI) or ARC definite/probable stent thromboses occurred in either cohort through 2-year follow-up. Conclusions: The clinical efficacy and safety outcomes observed in these small vessel and long lesion cohorts support the use of the PtCr-EES in the treatment of small diameter vessels and long lesions. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 06/2014; · 2.51 Impact Factor
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    ABSTRACT: The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment-elevation myocardial infarction and non-ST-segment-elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment-elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system-related delays in reperfusion include regionalization of ST-segment-elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention-capable hospitals, bypassing the percutaneous coronary intervention-capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non-ST-segment-elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non-ST-segment-elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.
    Circulation Research 06/2014; 114(12):1918-28. · 11.86 Impact Factor
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    ABSTRACT: To investigate the difference in neointimal hyperplasia (NIH) between ST-segment elevation myocardial infarction (STEMI), stable angina pectoris (SAP), and unstable angina pectoris (UAP).
    Coronary artery disease. 06/2014;
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    ABSTRACT: Troponin elevation is a risk factor for mortality in patients with non-ST-segment-elevation acute coronary syndromes. However, the prognosis of patients with troponin elevation and nonobstructive coronary artery disease (CAD) is unknown. Our objective was therefore to evaluate the impact of nonobstructive CAD in patients with non-ST-segment-elevation acute coronary syndromes and troponin elevation enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.
    Circulation Cardiovascular Interventions 05/2014; · 6.54 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate 1-year clinical outcomes of diabetic patients treated with the Absorb bioresorbable vascular scaffold (BVS). Clinical outcomes of diabetic patients after BVS implantation have been unreported. This study included 101 patients in the ABSORB Cohort B trial and the first consecutive 450 patients with 1 year of follow-up in the ABSORB EXTEND trial. A total of 136 diabetic patients were compared with 415 nondiabetic patients. In addition, 882 diabetic patients treated with everolimus-eluting metal stents (EESs) in pooled data from the SPIRIT trials (SPIRIT FIRST [A Clinical Trial of the Abbott Vascular XIENCE V® Everolimus Eluting Coronary Stent System], SPIRIT II [A Clinical Evaluation of the XIENCE V® Everolimus Eluting Coronary Stent System], SPIRIT III [Clinical Trial of the XIENCE V® Everolimus Eluting Coronary Stent System (EECSS)], SPIRIT IV Clinical Trial [Clinical Evaluation of the XIENCE V® Everolimus Eluting Coronary Stent System]) were used for the comparison by applying propensity score matching. The primary endpoint was a device-oriented composite endpoint (DoCE), including cardiac death, target vessel myocardial infarction, and target lesion revascularization at 1-year follow-up. The cumulative incidence of DoCE did not differ between diabetic and nondiabetic patients treated with the BVS (3.7% vs. 5.1%, p = 0.64). Diabetic patients treated with the BVS had a similar incidence of the DoCE compared with diabetic patients treated with EESs in the matched study group (3.9% for the BVS vs. 6.4% for EESs, p = 0.38). There were no differences in the incidence of definite or probable scaffold/stent thrombosis (0.7% for both diabetic and nondiabetic patients with the BVS; 1.0% for diabetic patients with the BVS vs. 1.7% for diabetic patients with EESs in the matched study group). In the present analyses, diabetic patients treated with the BVS showed similar rates of DoCEs compared with nondiabetic patients treated with the BVS and diabetic patients treated with EESs at 1-year follow-up. (ABSORB Clinical Investigation Cohort B; NCT00856856; ABSORB EXTEND Clinical Investigation; NCT01023789; A Clinical Trial of the Abbott Vascular XIENCE V® Everolimus Eluting Coronary Stent System [SPIRIT FIRST]; NCT00180453; A Clinical Evaluation of the XIENCE V® Everolimus Eluting Coronary Stent System [SPIRIT II]; NCT00180310; Clinical Trial of the XIENCE V® Everolimus Eluting Coronary Stent System (EECSS) [SPIRIT III]; NCT00180479; Clinical Evaluation of the XIENCE V® Everolimus Eluting Coronary Stent System [SPIRIT IV Clinical Trial]; NCT00307047).
    JACC. Cardiovascular Interventions 04/2014; · 1.07 Impact Factor
  • Gregg W Stone
    JACC. Cardiovascular Interventions 04/2014; · 1.07 Impact Factor

Publication Stats

26k Citations
7,094.52 Total Impact Points

Institutions

  • 2014
    • St. Michael's Hospital
      Toronto, Ontario, Canada
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2006–2014
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
    • University of Southampton
      Southampton, England, United Kingdom
    • University of Southern California
      • Division of Cardiovascular Medicine
      Los Angeles, CA, United States
    • Boston Biomedical Research Institute
      Boston, Massachusetts, United States
  • 2005–2014
    • CUNY Graduate Center
      New York City, New York, United States
    • Columbia University
      • Medical Center
      New York City, New York, United States
    • Saint Vincent Hospital
      Worcester, Massachusetts, United States
    • Weill Cornell Medical College
      New York City, New York, United States
    • Isala Klinieken
      Zwolle, Overijssel, Netherlands
  • 2000–2014
    • Cardiovascular Research Foundation
      New York City, New York, United States
    • New York Presbyterian Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine
      New York City, New York, United States
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
  • 2013
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
    • Jagiellonian University
      • Institute of Cardiology
      Cracovia, Lesser Poland Voivodeship, Poland
    • Liverpool Heart And Chest Hospital
      Liverpool, England, United Kingdom
    • Mayo Foundation for Medical Education and Research
      Rochester, Michigan, United States
    • Hospital Israelita Albert Einstein
      San Paulo, São Paulo, Brazil
    • Baylor Hamilton Heart and Vascular Hospital
      Dallas, Texas, United States
    • Stony Brook University Hospital
      Stony Brook, New York, United States
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
    • Florida Hospital
      Florida, United States
    • Ministry of Health (Israel)
      Yerushalayim, Jerusalem District, Israel
  • 2012–2013
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Academic Medical Center
      Amsterdam, North Holland, Netherlands
    • Saint Luke's Health System (KS, USA)
      Kansas City, Kansas, United States
    • University of Missouri - Kansas City
      • "Saint Luke's" Mid America Heart Institute
      Kansas City, MO, United States
    • Icahn School of Medicine at Mount Sinai
      • Division of Cardiology
      Manhattan, New York, United States
    • Vanderbilt University
      Nashville, Michigan, United States
    • Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene
      San Paulo, São Paulo, Brazil
    • Indiana Blood Center
      Indianapolis, Indiana, United States
    • University of Bergen
      Bergen, Hordaland, Norway
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
    • Inter American Foundation for Clinical Research, New York
      New York City, New York, United States
    • Deutsches Herzzentrum München
      • Klinik für Herz- und Kreislauferkrankungen
      München, Bavaria, Germany
    • Hadassah Medical Center
      Yerushalayim, Jerusalem District, Israel
    • Suez Canal University
      Al Ismā‘īlīyah, Al Ismā‘īlīyah, Egypt
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
  • 2011–2013
    • Methodist Hospitals
      Gary, Indiana, United States
    • New York Methodist Hospital
      New York City, New York, United States
    • Mount Sinai Medical Center
      New York City, New York, United States
    • Skåne University Hospital
      Malmö, Skåne, Sweden
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
    • Università degli Studi di Perugia
      • Department of Internal Medicine
      Perugia, Umbria, Italy
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
    • The Clinical Trial Center, LLC
      Jenkintown, Pennsylvania, United States
  • 2010–2013
    • Universität Ulm
      • Clinic of Internal Medicine II
      Ulm, Baden-Württemberg, Germany
    • Nanjing Medical University
      • Department of Cardiology
      Nan-ching, Jiangsu Sheng, China
    • University of Catania
      • Department of Surgery (CHIR)
      Catania, Sicily, Italy
    • The Christ Hospital
      Cincinnati, Ohio, United States
    • Yale-New Haven Hospital
      • Cardiovascular Medicine Program
      New Haven, Connecticut, United States
    • Policlinico Casilino
      Romeno, Trentino-Alto Adige, Italy
    • Kaiser Permanente
      • Department of Cardiology
      Oakland, CA, United States
    • Medical University of South Carolina
      Charleston, South Carolina, United States
    • California State University, Sacramento
      Sacramento, California, United States
    • NorthShore University HealthSystem
      Chicago, Illinois, United States
    • New York Medical College
      New York City, New York, United States
    • Fortis Escorts Heart Institute
      New Dilli, NCT, India
  • 2009–2013
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, CA, United States
    • Harvard University
      Cambridge, Massachusetts, United States
    • Centre Hospitalier Universitaire de Caen
      Caen, Lower Normandy, France
    • Lifespan
      Providence, Rhode Island, United States
    • Bryn Mawr College
      Bryn Mawr, Pennsylvania, United States
  • 2008–2013
    • Amedeo Avogadro University of Eastern Piedmont
      Novara, Piedmont, Italy
    • Azienda Ospedaliero Universitaria Maggiore della Carità
      • Department of Cardiology 2
      Novara, Piedmont, Italy
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
  • 2004–2013
    • Duke University Medical Center
      • • Duke Clinical Research Institute
      • • Department of Medicine
      • • Division of Cardiology
      Durham, NC, United States
    • Sharp Chula Vista Medical Center in San Diego
      San Diego, California, United States
  • 2011–2012
    • Tel Aviv University
      Tell Afif, Tel Aviv, Israel
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2009–2012
    • Stanford University
      • Division of Cardiovascular Medicine
      Palo Alto, California, United States
  • 2008–2012
    • Auckland City Hospital
      Окленд, Auckland, New Zealand
  • 2005–2012
    • Mayo Clinic - Rochester
      • Department of Cardiovascular Diseases
      Rochester, MN, United States
  • 1999–2012
    • Washington Hospital Center
      Washington, Washington, D.C., United States
    • Waikato Hospital
      Hamilton City, Waikato, New Zealand
  • 2010–2011
    • Wake Forest School of Medicine
      • Section on Cardiology
      Winston-Salem, North Carolina, United States
  • 2008–2011
    • New York University
      • Department of Medicine
      New York City, NY, United States
  • 2006–2011
    • University of Kentucky
      • Gill Heart Institute
      Lexington, KY, United States
  • 2002–2011
    • Beth Israel Deaconess Medical Center
      • Department of Medicine
      Boston, MA, United States
    • Rambam Medical Center
      • Department of Cardiology
      H̱efa, Haifa District, Israel
    • Cleveland Clinic
      • Department of Cardiovascular Medicine
      Cleveland, OH, United States
  • 2008–2009
    • London School of Hygiene and Tropical Medicine
      • Department of Medical Statistics
      London, ENG, United Kingdom
    • Brigham and Women's Hospital
      • • Center for Brain Mind Medicine
      • • Division of General Internal Medicine and Primary Care
      Boston, MA, United States
  • 2007–2008
    • Metropolitan Heart and Vascular Institute
      Minneapolis, Minnesota, United States
    • Emory University
      • School of Medicine
      Atlanta, GA, United States
    • Tufts University
      • Center of Cancer Systems Biology at Caritas St. Elizabeth's Medical Center
      Georgia, United States
  • 2006–2008
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2006–2007
    • Guthrie Health
      New York City, New York, United States
  • 1995–2007
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 1989–2007
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
  • 2003–2006
    • North Carolina Clinical Research
      Raleigh, North Carolina, United States
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States
    • Duke University
      Durham, North Carolina, United States
    • Ochsner
      • Department of Cardiology
      New Orleans, LA, United States
  • 2000–2005
    • Lenox Hill Hospital
      New York City, New York, United States
  • 2003–2004
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2001
    • Brooke Army Medical Center
      Houston, Texas, United States
    • Washington Research Foundation
      Seattle, Washington, United States
  • 1995–1999
    • El Camino Hospital
      Mountain View, California, United States
  • 1994
    • Stanford Medicine
      • Division of Cardiovascular Medicine
      Stanford, California, United States