Gregg W Stone

CUNY Graduate Center, New York, New York, United States

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Publications (981)8569.68 Total impact

  • Allen Jeremias, Gregg W. Stone
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    ABSTRACT: To guide the decision‐making process for coronary revascularization in the cath lab, FFR has been proven to enhance patient outcomes and reduce costs compared with angiography aloneHowever, FFR is prone to artifacts, may yield inaccurate results, and is under‐utilized in practice, in part because of the requisite use of hyperemia which is cumbersome and produces variable clinical responsesInterest is growing in resting indices such as Pd/Pa and iFR that do not require hyperemia and therefore simplify the procedure and allow for multiple pre‐ and post‐procedural lesion assessmentsTwo large randomized trials are ongoing comparing clinical outcomes with iFR vs. FFR that may determine the future adoption of resting coronary indices
    Catheterization and Cardiovascular Interventions 03/2015; 85(4). · 2.51 Impact Factor
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    ABSTRACT: Systemic hypothermia may reduce infarct size if established before reperfusion. The large surface area of the bowel may facilitate rapid hypothermia. We therefore examined the feasibility, safety, and efficacy of hypothermia induced by an automated peritoneal lavage system in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Patients with ST-segment-elevation myocardial infarction within 6 hours of symptom onset were randomized to peritoneal hypothermia before and for 3 hours after percutaneous coronary intervention versus control. The primary safety end point was the 30-day composite rate of death, reinfarction, ischemia-driven target vessel revascularization, major bleeding, sepsis, pneumonia, peritonitis, severe arrhythmia, or renal failure. The primary efficacy end point was infarct size assessed by cardiac MRI on day 3 to 5. Fifty-four patients were randomized at 7 centers to hypothermia (n=28) versus control (n=26). Hypothermia was successfully initiated in 96.3% of patients, and median [interquartile range] temperature at first balloon inflation was 34.7 [34.0-34.9]°C. Median door-to-balloon times in the hypothermia and control groups were 62 [51-81] and 47 [37-55] minutes, respectively (P=0.007). The primary safety end point occurred in 6 (21.4%) and 0 (0%) patients in the hypothermia and control groups, respectively (P=0.01), including 3 versus 0 stent thrombosis events. Infarct size was 17.2% [15.1-20.6] and 16.1% [10.0-22.2] in the hypothermia and control groups, respectively (P=0.54). Peritoneal hypothermia is feasible and achieves rapid cooling with only a modest increase in treatment times in the setting of ST-segment-elevation myocardial infarction. However, in the present randomized trial, peritoneal hypothermia was associated with an increased rate of adverse events without reducing infarct size. http://www.clinicaltrials.gov. Unique identifier: NCT01655433. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Interventions 03/2015; 8(3). · 6.98 Impact Factor
  • The American Journal of Cardiology. 02/2015;
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    ABSTRACT: The aim of this study was to examine the efficacy and bleeding outcomes of cangrelor in patients in the CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI]) who underwent percutaneous coronary intervention with bivalirudin. Cangrelor is a potent intravenous P2Y12 inhibitor with rapid onset and offset. In the CHAMPION PHOENIX, cangrelor compared with clopidogrel significantly reduced 48-h ischemic events including stent thrombosis, without increasing major bleeding. Bivalirudin has demonstrated ischemic outcomes similar to those with heparin plus glycoprotein IIb/IIIa inhibition, with reduced bleeding but increased early stent thrombosis. In the modified intent-to-treat population, 2,059 patients (18.8%) received bivalirudin, with 1,014 patients in the cangrelor treatment arm and 1,045 in the clopidogrel treatment arm. At 48 h, the primary endpoint of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis was lower with cangrelor versus clopidogrel (48 [4.7%] vs. 70 [6.7%]; odds ratio [OR]: 0.68, p = 0.047). Death was similar in both arms (2 [0.2%] vs. 2 [0.2%]). Myocardial infarction was reduced by cangrelor (37 [3.6%] vs. 59 [5.6%]; OR: 0.63, p = 0.03), as was death/myocardial infarction (39 [3.8%] vs. 61 [5.8%]; OR: 0.65, p = 0.04). Cangrelor was associated with a nonsignificant trend toward less stent thrombosis (7 [0.7%] vs. 15 [1.4%]; OR: 0.48, p = 0.10), which was evident within 2 hours after percutaneous coronary intervention (p = 0.057). GUSTO (Global Use of Strategies to Open Occluded Arteries) severe bleeding was similar in both arms (2/1,021 [0.2%] vs. 2/1,055 [0.2%]) as were other bleeding definitions and transfusions. Efficacy and safety results were consistent in patients with stable angina, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction (p for interaction: 0.62 and 0.29). Cangrelor may offer an attractive benefit risk profile when used in combination with bivalirudin. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC. Cardiovascular interventions. 02/2015;
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    ABSTRACT: The MGuard, a bare metal stent covered with a polymer mesh, was designed to reduce distal embolization during percutaneous coronary intervention in ST-segment-elevation myocardial infarction. In the MGUARD for Acute ST Elevation Reperfusion trial, the primary end point of complete ST-segment resolution was significantly improved with the MGuard compared with control. We evaluated 1-year clinical and angiographic results. Patients with ST-segment-elevation myocardial infarction ≤12 hours undergoing primary percutaneous coronary intervention of a single de novo native lesion were randomized to the MGuard versus any commercially available metallic stent (39.8% drug-eluting). Clinical follow-up was performed through 1 year, and angiography at 13 months was planned in 50 MGuard patients. There was no difference in major adverse cardiac events (1.8% versus 2.3%; P=0.75) at 30 days between the groups. Major adverse cardiac events at 1 year were higher with the MGuard, driven by greater ischemia-driven target lesion revascularization (8.6% versus 0.9%; P=0.0003). Conversely, mortality tended to be lower with the MGuard at 30 days (0% versus 1.9%; P=0.04) and at 1 year (1.0% versus 3.3%; P=0.09). Late lumen loss at 13 months in the MGuard was 0.99±0.80 mm, and binary restenosis was 31.6%. In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, a trend toward reduced 1-year mortality was present in patients treated with the MGuard stent. Target lesion revascularization and major adverse cardiac events rates during follow-up were higher in the MGuard group than in the control stent group, and angiographic late loss of the MGuard was consistent with that expected from bare metal stents. http://www.clinicaltrials.gov. Unique identifier: NCT01368471. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Interventions 02/2015; 8(2). · 6.98 Impact Factor
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    ABSTRACT: Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood. Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts. A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation. http://www.clinicaltrials.gov. Unique identifier: NCT00638794. © 2014 American Heart Association, Inc.
    Circulation Cardiovascular Interventions 01/2015; 8(1). · 6.54 Impact Factor
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    ABSTRACT: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter registry of 8,582 consecutive stable and unstable patients who underwent percutaneous coronary intervention using a drug-eluting stent. We sought to identify key morphologic features leading to ST-segment elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI) or unstable angina pectoris (UA) versus stable coronary artery disease (CAD) presentation. In the prespecified grayscale and virtual histology (VH) substudy of ADAPT-DES, preintervention imaging identified 676 patients with a single culprit lesion. The relation between lesion morphology and clinical presentation was compared among patients with (1) STEMI, (2) NSTEMI or UA, and (3) stable CAD. Intravascular ultrasound identified more plaque rupture and VH thin-cap fibroatheroma (TCFA) in STEMI lesions compared with NSTEMI/UA or stable CAD lesions; conversely, fibroatheromas appeared more often calcified with a thick fibrous cap in stable CAD. Minimum lumen cross-sectional area (MLA) was smaller with larger plaque burden and positive remodeling in STEMI lesions. Lesions with plaque rupture versus those without plaque rupture showed higher prevalence of VH-TCFA and larger plaque burden with positive remodeling, especially in patients with STEMI. Multivariate analysis showed that in the lesions with plaque rupture, plaque burden at the MLA site was the only independent predictor for STEMI (cutoff of plaque burden = 85%) and in lesions without plaque rupture, MLA was the only independent predictor for STEMI (cutoff of MLA = 2.3 mm(2)). In conclusion, culprit lesions causing STEMI have smaller lumen areas, greater plaque burden, and more plaque rupture or VH-TCFA compared with NSTEMI/UA or stable CAD; in lesions with plaque rupture, only plaque burden predicted STEMI, and in lesions without plaque rupture, only MLA area predicted STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 01/2015; · 3.43 Impact Factor
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    ABSTRACT: Aims To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Methods and results Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43–1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34–1.45); in intermediate anatomical SYNTAX scores (23–32), the predicted OR was 0.93 (95% PI 0.53–1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). Conclusion The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
    European Heart Journal 01/2015; · 14.72 Impact Factor
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    ABSTRACT: This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).
    JACC: Cardiovascular Imaging. 01/2015;
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    ABSTRACT: In the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) treated with bivalirudin had lower bleeding and mortality rates, but higher acute stent thrombosis rates compared with heparin + a glycoprotein IIb/IIIa inhibitor (GPI). Subsequent changes in primary PCI, including the use of potent P2Y12 inhibitors, frequent radial intervention, and pre-hospital medication administration, were incorporated into the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial, which assigned 2,218 patients to bivalirudin versus heparin ± GPI before primary PCI. The goal of this study was to examine the outcomes of procedural anticoagulation with bivalirudin versus heparin ± GPI for primary PCI, given the evolution in primary PCI. Databases from HORIZONS-AMI and EUROMAX were pooled for patient-level analysis. The Breslow-Day test evaluated heterogeneity between trials. A total of 5,800 patients were randomized to bivalirudin (n = 2,889) or heparin ± GPI (n = 2,911). The radial approach was used in 21.3% of patients, prasugrel/ticagrelor was used in 18.1% of patients, and GPI was used in 84.8% of the control group. Bivalirudin compared with heparin ± GPI resulted in reduced 30-day rates of major bleeding (4.2% vs. 7.8%; relative risk [RR]: 0.53; 95% confidence interval [CI]: 0.43 to 0.66; p < 0.0001), thrombocytopenia (1.4% vs. 2.9%, RR: 0.48; 95% CI: 0.33 to 0.71; p = 0.0002), and cardiac mortality (2.0% vs. 2.9%; RR: 0.70; 95% CI: 0.50 to 0.97; p = 0.03), with nonsignificantly different rates of reinfarction, ischemia-driven revascularization, stroke, and all-cause mortality. Bivalirudin resulted in increased acute (<24 h) stent thrombosis rates (1.2% vs. 0.2%; RR: 6.04; 95% CI: 2.55 to 14.31; p < 0.0001), with nonsignificantly different rates of subacute stent thrombosis. Composite net adverse clinical events were lower with bivalirudin (8.8% vs. 11.9%; RR: 0.74; 95% CI: 0.63 to 0.86; p < 0.0001). There was no significant heterogeneity between the 2 trials for these outcomes, and results were consistent across major subgroups. Despite increased acute stent thrombosis, primary PCI with bivalirudin improved 30-day net clinical outcomes, with significant reductions in major bleeding, thrombocytopenia, and transfusions compared with heparin ± GPI, results that were consistent with evolution in PCI technique and pharmacotherapy. (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966) (European Ambulance Acute Coronary Syndrome Angiography [EUROMAX]; NCT01087723). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 01/2015; 65(1):27-38. · 15.34 Impact Factor
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    ABSTRACT: Women are more likely than men to experience adverse cardiac events after ST-elevation myocardial (STEMI). Whether differences in infarct size or reperfusion contribute to sex differences in outcomes is unknown. We compared baseline and procedural characteristics, angiographic and electrocardiographic indices of reperfusion, microvascular obstruction, infarct size, and clinical outcomes in 118 women and 334 men with anterior STEMI enrolled in the INFUSE-AMI randomized trial of intralesion abciximab and aspiration thrombectomy (NCT00976521). Infarct size was assessed by cardiac magnetic resonance imaging at 30days, and clinical end points were adjudicated by an independent committee. Women were older, were more commonly affected by hypertension and renal impairment, and had a 50.5-minute longer delay to reperfusion. There were no differences in infarct size, microvascular obstruction, or reperfusion success. At 30days, major adverse cardiac events (MACE), defined as death, reinfarction, new-onset severe heart failure, or rehospitalization for heart failure, were more common in women (11.1% vs 5.4%, hazard ratio 2.09, 95% CI 1.03-4.27, P = .04). After multivariable adjustment, age, but not sex or time to reperfusion, was an independent predictor of MACE. In the INFUSE-AMI randomized trial, women with anterior STEMI experienced a higher rate of MACE, attributable to older age. Despite longer delay from symptom onset to reperfusion therapy, there was no difference between women and men in infarct size or reperfusion success. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Heart Journal 01/2015; 169(1):86-93. · 4.56 Impact Factor
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    ABSTRACT: Objectives This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).Background NIRS-detected, lipid-rich plaques (LRPs) and IVUS-detected attenuated plaques are considered to be vulnerable.Methods IVUS-attenuated plaque and NIRS-LRP (yellow or tan block chemogram) were compared with histopathology in 1,943 sections of 103 coronary arteries from 56 autopsied hearts.Results IVUS-superficial attenuation and NIRS-LRP showed a similar high specificity of approximately 95%, whereas IVUS-superficial attenuation alone had a poor sensitivity (vs. NIRS-LRP) in detecting FAs (36% vs. 47%; p = 0.001). Compared with FA sections with superficial attenuation, FA sections without superficial attenuation had a smaller plaque burden (57.1% vs. 67.7%), a larger arc of calcium (79.7° vs. 16.8°), and a lower prevalence of a ≥20% histological necrotic core (28% vs. 50%) or late FA (14% vs. 37%; all p textless 0.05). Compared with FA sections with NIRS-LRP, FA sections without NIRS-LRP showed a smaller plaque burden (58.0% vs. 63.3%) and a lower prevalence of a ≥20% necrotic core (27% vs. 46%). Conversely, non-FAs with NIRS-LRP (vs. non-FAs without LRP) showed a larger plaque burden (55.1% vs. 46.3%), a greater prevalence of a ≥20% histological lipid pool (34% vs. 5%), and mostly pathological intimal thickening (50%) or fibrocalcific plaque (33%). When sections showed either IVUS attenuation or NIRS-LRP, the sensitivity for predicting a FA was significantly higher compared with IVUS attenuation alone (63% vs. 36%; p textless 0.001) or NIRS-LRP alone (63% vs. 47%; p textless 0.001). When sections showed both IVUS attenuation and NIRS-LRP, the positive predictive value improved compared with IVUS attenuation alone (84% vs. 66%; p textless 0.001) or NIRS-LRP alone (84% vs. 65%; p textless 0.001).Conclusions NIRS-LRP was more accurate than IVUS for predicting plaque containing a necrotic core or a large lipid pool, and the combination was more accurate than either alone.
    JACC Cardiovascular Imaging 01/2015; · 6.99 Impact Factor
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    ABSTRACT: Infarct size after ST-segment elevation myocardial infarction (STEMI) is associated with long-term clinical outcomes. However, there is insufficient information correlating creatine kinase-MB (CK-MB) or troponin levels to infarct size and infarct location in first-time occurrence of STEMI. We, therefore, assessed the utility of CK-MB measurements after primary percutaneous coronary intervention of a first anterior STEMI using bivalirudin anticoagulation in patients who were randomized to intralesion abciximab versus no abciximab and to manual thrombus aspiration versus no aspiration. Infarct size (as a percentage of total left ventricular [LV] mass) and LV ejection fraction (LVEF) were evaluated by cardiac magnetic resonance imaging at 30 days and correlated to peak CK-MB. Peak CK-MB (median 240 IU/L; interquartile range 126 to 414) was significantly associated with infarct size and with LVEF (r = 0.67, p <0.001; r = -0.56, p <0.001, respectively). A large infarct size (greater than or equal the median, defined as 17% of total LV mass) and LVEF ≤40% were more common in the highest peak CK-MB tertile group than in the other tertiles (87.6% vs 49.5% vs 9.1%, p <0.001; 43.2% vs 14.0% vs 4.6%, p <0.001, respectively). Peak CK-MB of at least 300 IU/L predicted with moderate accuracy both a large infarct size (area under the curve 0.88) and an LVEF ≤40% (area under the curve 0.78). Furthermore, CK-MB was an independent predictor of 1-year major adverse cardiac events (hazard ratio 1.42 per each additional 100 IU/L [1.20 to 1.67], p <0.001). In conclusion, CK-MB measurement is useful in estimating infarct size and LVEF and in predicting 1-year clinical outcomes after primary percutaneous coronary intervention for first anterior STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 12/2014; · 3.43 Impact Factor
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    ABSTRACT: Objectives: We sought to evaluate the feasibility and safety of catheter-based supersaturated oxygen (SSO2) delivery via the left main coronary artery (LMCA) following primary percutaneous coronary intervention (PCI).Background: In the multicenter, randomized AMIHOT II trial, SSO2 delivered into the proximal or mid left anterior descending (LAD) artery via an indwelling intracoronary infusion catheter in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) following primary PCI significantly reduced infarct size but resulted in a numerically higher incidence of safety events.Methods: Patients with acute anterior STEMI presenting within 6 hours of symptom onset were enrolled at 3 centers. Following successful LAD stenting, SSO2 was infused into the LMCA via a diagnostic catheter for 60 minutes. The primary safety endpoint was the 30-day rate of target vessel failure (composite of death, reinfarction, or target vessel revascularization). Cardiac magnetic resonance imaging (cMRI) was performed at 3-5 days and 30 days to assess infarct size.Results: Twenty patients with acute anterior STEMI were enrolled. The infarct lesion was located in the proximal LAD in 7 cases (35%) and the mid LAD in 13 cases (65%). Following primary PCI, SSO2 was delivered successfully in all cases. Target vessel failure within 30 days occurred in 1 patient (5%). Median [interquartile range] infarct size was 13.7% [5.4%-20.6%] at 3-5 days and 9.6% [2.1%-14.5%] at 30 days.Conclusions. Following primary PCI in acute anterior STEMI, infusion of SSO2 via the LMCA is feasible, and is associated with a favorable early safety and efficacy profile. This article is protected by copyright. All rights reserved.
    Catheterization and Cardiovascular Interventions 12/2014; · 2.51 Impact Factor
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    ABSTRACT: The accuracy of the 12-lead electrocardiogram in detecting coronary artery occlusion is limited. We sought to determine the incidence, distribution, and outcomes of patients who have total occlusion of the culprit artery but present with non-ST-segment elevation myocardial infarction (NSTEMI). The randomized Acute Catheterization and Urgent Intervention Triage Strategy trial enrolled 13,819 patients presenting with non-ST-segment elevation acute coronary syndromes who underwent an early invasive strategy. The present study includes 1,319 patients with baseline biomarker elevation (NSTEMI) and no history of coronary artery bypass graft who underwent percutaneous coronary intervention of a single culprit vessel. We compared the baseline characteristics and outcomes according to whether the culprit vessel was occluded (baseline Thrombolysis In Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit artery was present in 262 of 1,319 (19.9%) patients. The incidence of coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI because of right coronary, left circumflex, and left anterior descending artery disease, respectively. Patients with an occluded culprit artery were more commonly men and had ST-segment deviation ≥1 mm. One-year outcomes, including death (3.5% vs 3.0%, p = 0.68) and myocardial infarction (8.4% vs 9.6%, p = 0.47), did not differ significantly between patients with versus without occluded culprit arteries, respectively. In conclusion, the present study demonstrates that the culprit artery is totally occluded in approximately 1 in 5 patients presenting with NSTEMI and single-vessel disease; however, the presence of total occlusion in NSTEMI was not associated with an incremental hazard of death or reinfarction at 1 year. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 11/2014; 115(4). · 3.43 Impact Factor
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    ABSTRACT: Target vessel revascularization (TVR) may compromise the benefits of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction (STEMI) We set out to identify the predictors and examine the impact of TVR after STEMI in patients receiving a coronary stent. In HORIZONS-AMI, 3,602 patients with STEMI were randomized to bivalirudin versus heparin and a glycoprotein IIb/IIIa inhibitor. Stents were implanted in 3,202 patients (2,982 were randomized to bare-metal stents versus paclitaxel-eluting stents, and 220 received nonrandomized stents). Target vessel revascularization occurred in 219 patients (6.9%) at 1 year and in 437 patients (14.4%) at 3 years. Target vessel revascularization was ischemia-driven in 418 cases (95.7%). Target vessel revascularization was due to restenosis in 219 patients (50.1%), definite stent thrombosis in 124 (28.4%), and disease progression in 94 (21.5%). Independent predictors of TVR were more extensive coronary artery disease, smaller vessel size, longer lesion length and the number of stents implanted, post-percutaneous coronary intervention diameter stenosis, symptom onset to balloon time, treatment with bare-metal stents rather than paclitaxel-eluting stents, and scheduled angiographic follow-up. Target vessel revascularization was an independent predictor of subsequent myocardial infarction (hazard ratio [HR] 5.25, P < .0001), ST (HR 5.98, P < .0001), and major bleeding (HR 5.25, P < .0001) but not mortality (HR 0.88, P = .61). In HORIZONS-AMI, TVR within 3 years after stent implantation was performed in ~1 of every 7 patients and was associated with more extensive coronary disease, more complex procedures, and bare metal stents. Target vessel revascularization was often due to stent thrombosis and disease progression as well as restenosis and was strongly associated with adverse outcomes but not mortality. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Heart Journal 11/2014; 169(2). · 4.56 Impact Factor
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    ABSTRACT: Bioresorbable vascular scaffolds (BRS) represent a novel approach to provide transient vessel support to drug-delivery capability without the long-term limitations of metallic drug-eluting stents (DES). The technology has the potential to overcome many of the safety concerns associated with metallic DES and possibly even convey further clinical benefit. In particular, the BRS are designed to provide short-term lumen support, and after being completely bioresorbed, eliminate the permanent caging typical of metallic DES. However, this technology has required new imaging modalities and methodologies for its assessment because the design, degradation rate, loss of mechanical property, and drug deliverability may affect its safety and efficacy. We provide an overview of all existing methods for assessing bioresorbable devices, from noninvasive to invasive, from light to sound based, and from morphological to functional parameters.
    JACC. Cardiovascular imaging 11/2014; 7(11):1130-1148. · 14.29 Impact Factor
  • JACC Cardiovascular Interventions 11/2014; · 7.44 Impact Factor

Publication Stats

36k Citations
8,569.68 Total Impact Points

Institutions

  • 2005–2015
    • CUNY Graduate Center
      New York, New York, United States
    • Weill Cornell Medical College
      New York City, New York, United States
    • St. Vincent Hospital
      Green Bay, Wisconsin, United States
    • Isala Klinieken
      Zwolle, Overijssel, Netherlands
  • 2000–2015
    • Cardiovascular Research Foundation
      New York City, New York, United States
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2014
    • University of Toronto
      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
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2005–2014
    • Columbia University
      • Division of Cardiology
      New York, New York, United States
  • 2000–2014
    • New York Presbyterian Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine
      New York City, New York, United States
  • 2013
    • 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
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
    • Università degli Studi di Torino
      • Department of Medical Science
      Torino, Piedmont, Italy
    • University College London
      Londinium, England, United Kingdom
    • Mayo Foundation for Medical Education and Research
      Rochester, Michigan, United States
    • Nanjing Medical University
      • Department of Cardiology
      Nan-ching, Jiangsu Sheng, China
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
    • Hôpital du Sacré-Coeur de Montréal
      Montréal, Quebec, Canada
    • Florida Hospital
      Florida, United States
    • Jagiellonian University
      • Institute of Cardiology
      Cracovia, Lesser Poland Voivodeship, Poland
  • 2012–2013
    • Amedeo Avogadro University of Eastern Piedmont
      Novara, Piedmont, Italy
    • University of Bergen
      • Institute of Medicine
      Bergen, Hordaland, Norway
    • Icahn School of Medicine at Mount Sinai
      • Division of Cardiology
      Manhattan, New York, United States
    • University of Missouri - Kansas City
      • "Saint Luke's" Mid America Heart Institute
      Kansas City, MO, United States
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
    • Deutsches Herzzentrum München
      • Klinik für Herz- und Kreislauferkrankungen
      München, Bavaria, Germany
    • Saint Luke's Health System (KS, USA)
      Kansas City, Kansas, United States
    • Inter American Foundation for Clinical Research, New York
      New York City, New York, United States
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Academic Medical Center
      Amsterdamo, North Holland, Netherlands
    • Indiana Blood Center
      Indianapolis, Indiana, United States
    • Suez Canal University
      • Department of Cardiology
      Al Ismā‘īlīyah, Al Ismā‘īlīyah, Egypt
  • 2011–2013
    • New York Methodist Hospital
      New York City, New York, United States
    • Mount Sinai Medical Center
      New York City, New York, United States
    • Methodist Hospitals
      Gary, Indiana, United States
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
    • The Harvard Drug Group
      Ливония, Michigan, United States
    • Skåne University Hospital
      Malmö, Skåne, Sweden
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
    • CardioVasculäres Centrum Frankfurt
      Frankfurt, Hesse, Germany
    • The Clinical Trial Center, LLC
      Jenkintown, Pennsylvania, United States
  • 2010–2013
    • Universität Ulm
      • Clinic of Internal Medicine II
      Ulm, Baden-Württemberg, Germany
    • 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
    • NorthShore University HealthSystem
      Chicago, Illinois, United States
    • Fortis Escorts Heart Institute
      New Dilli, NCT, India
    • New York Medical College
      New York City, New York, United States
    • University of Catania
      • Department of Surgery (CHIR)
      Catania, Sicily, Italy
  • 2006–2013
    • Duke University Medical Center
      • • Duke Clinical Research Institute
      • • Department of Medicine
      Durham, NC, United States
  • 2002–2013
    • Rambam Medical Center
      • Department of Cardiology
      H̱efa, Haifa, Israel
    • Cleveland Clinic
      • Department of Cardiovascular Medicine
      Cleveland, OH, United States
  • 2011–2012
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
    • Tel Aviv University
      Tell Afif, Tel Aviv, Israel
  • 2009–2012
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
    • Stanford University
      • Division of Cardiovascular Medicine
      Palo Alto, California, United States
    • Centre Hospitalier Universitaire de Caen
      Caen, Lower Normandy, France
    • Harvard University
      Cambridge, Massachusetts, United States
    • Bryn Mawr College
      Bryn Mawr, Pennsylvania, United States
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, MA, United States
  • 2008–2012
    • Auckland City Hospital
      Окленд, Auckland, New Zealand
    • Azienda Ospedaliero Universitaria Maggiore della Carità
      • Department of Cardiology 2
      Novara, Piedmont, Italy
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
    • New York University
      • Medicine
      New York City, NY, United States
  • 2007–2012
    • Mayo Clinic - Rochester
      • Department of Cardiovascular Diseases
      Rochester, MN, United States
  • 1999–2012
    • Washington Hospital Center
      Washington, Washington, D.C., United States
  • 2010–2011
    • Wake Forest School of Medicine
      • Section on Cardiology
      Winston-Salem, North Carolina, United States
  • 2003–2011
    • North Carolina Clinical Research
      Raleigh, North Carolina, United States
  • 2008–2009
    • London School of Hygiene and Tropical Medicine
      • Department of Medical Statistics
      London, ENG, United Kingdom
  • 1995–2007
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 1989–2007
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
  • 2003–2004
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2000–2004
    • Lenox Hill Hospital
      New York City, New York, United States
  • 2002–2003
    • Beth Israel Deaconess Medical Center
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2001
    • 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