Gregg Stone

Publications (12)51.75 Total impact

• Article: Comparison of Bivalirudin versus Bivalirudin plus glycoprotein IIb/IIIa inhibitor versus heparin plus glycoprotein IIb/IIIa inhibitor in patients with acute coronary syndromes having percutaneous intervention for narrowed saphenous vein aorto-coronary grafts (the ACUITY trial investigators).

  Dinesh Kumar, George Dangas, Roxana Mehran, Ajay Kirtane, Michel Bertrand, Ramin Ebrahimi, Giulio Guagliumi, Somjot Brar, Martin Fahy, Eric Heller, Jeffrey Moses, Gregg Stone
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  ABSTRACT: Clinical outcomes in patients with acute coronary syndromes randomized in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial who underwent percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) were examined. The ACUITY trial assessed the safety and efficacy of bivalirudin alone versus bivalirudin plus a glycoprotein (GP) IIb/IIIa inhibitor versus heparin plus a GP IIb/IIIa inhibitor in 13,819 patients with moderate- and high-risk acute coronary syndromes, 7,789 of whom underwent PCI. A total of 329 patients (4.2%) underwent PCI of SVGs in ACUITY. The primary end points at 30 days were composite ischemia or major adverse cardiac events (death, myocardial infarction, or unplanned target vessel revascularization), major bleeding (unrelated to coronary artery bypass grafting), and net adverse clinical events (composite ischemia or major bleeding). The rates of ischemic, bleeding, and net clinical end points were similar with bivalirudin monotherapy, bivalirudin plus a GP IIb/IIIa inhibitor, and heparin plus a GP IIb/IIIa inhibitor. Net adverse clinical outcome rates at 30 days were 22%, 26%, and 22% (p = 0.67), respectively, for the 3 groups. Major adverse cardiac event rates at 1 year were 37%, 37%, and 43% (p = 0.95), respectively. Minor bleeding unrelated to coronary artery bypass grafting at 30 days was significantly lower with bivalirudin alone compared with heparin plus a GP IIb/IIIa inhibitor (26% vs 38%, p = 0.05). In conclusion, bivalirudin is an effective anticoagulant in PCI of SVGs in acute coronary syndromes, with similar rates of major adverse cardiac events and net adverse cardiac events and lower minor bleeding complications in comparison with heparin plus a GP IIb/IIIa inhibitor or bivalirudin plus a GP IIb/IIIa inhibitor.
  The American journal of cardiology 10/2010; 106(7):941-5. · 3.58 Impact Factor
• Article: Meta-analysis of angiographic versus intravascular ultrasound parameters of drug-eluting stent efficacy (from TAXUS IV, V, and VI).

  Esteban Escolar, Gary S Mintz, Jeffrey Popma, Aleksandra Michalek, Sang Wook Kim, Lazar Mandinov, Joerg Koglin, Gregg Stone, Stephen G Ellis, Eberhard Grube, Keith D Dawkins, Neil J Weissman
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  ABSTRACT: Both quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) are currently used to assess in-stent restenosis. This study aimed to use standardized imaging and clinical follow-up to compare QCA parameters with several IVUS parameters to evaluate their strengths and weaknesses for detecting in-stent restenosis in a drug-eluting stent population. A subset of patients from the TAXUS IV, V, and VI studies was evaluated. The subset, which included 216 TAXUS-treated patients and 191 bare-metal stent-treated patients, had complete IVUS and QCA performed at baseline and follow-up. As expected, all QCA and IVUS parameters were consistent with less intimal hyperplasia in TAXUS patients than controls. The overall incidence of QCA binary restenosis was 14.0%, which was 9.3% in TAXUS-treated patients and 19% in bare-metal stent-treated patients (p = 0.0008). Regression analysis showed that QCA late lumen loss and percentage of diameter stenosis correlated only moderately with the various IVUS measures of neointimal hyperplasia for the combined group of patients (TAXUS + bare-metal stent), as well as for the TAXUS-treated and bare-metal stent-treated patients separately. However, in general, correlations within the control (bare-metal stent) group tended to be stronger than within the TAXUS group. The strongest correlation was between QCA percentage of diameter stenosis and IVUS percentage of intimal hyperplasia in the overall group and the control group. The strongest IVUS predictor of QCA binary restenosis at 9 months was maximum percentage of intimal hyperplasia, with an overall C = 0.91 and p <0.001. In conclusion, the QCA and IVUS parameters used to evaluate drug-eluting stent efficacy showed a moderate correlation with IVUS percentage of intimal hyperplasia, reliably predicting QCA binary in-stent restenosis.
  The American Journal of Cardiology 08/2007; 100(4):621-6. · 3.37 Impact Factor
• Article: Oral rapamycin after coronary bare-metal stent implantation to prevent restenosis: the Prospective, Randomized Oral Rapamycin in Argentina (ORAR II) Study.

  Alfredo E Rodriguez, Juan F Granada, Máximo Rodriguez-Alemparte, Cesar F Vigo, Juan Delgado, Carlos Fernandez-Pereira, Antonio Pocovi, Alfredo M Rodriguez-Granillo, Daryl Schulz, Albert E Raizner, Igor Palacios, William O'Neill, Grzegorz L Kaluza, Gregg Stone
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  ABSTRACT: The purpose of this study was to assess the role of oral rapamycin in decreased restenosis after bare metal stent implantation. Small observational studies suggest that the administration of oral rapamycin reduces angiographic restenosis after bare metal stent implantation. Between September 2003 and September 2004, 100 patients were randomized to either oral rapamycin (6-mg loading dose given 2.7 h before intervention followed by 3 mg/day for 14 days) plus diltiazem 180 mg/day or no therapy after the implantation of a coronary bare metal stent design. The primary study end point was incidence of angiographic binary restenosis and late loss at nine months. The secondary end points were target lesion revascularization, target vessel revascularization, and incidence of major adverse cardiovascular events at 1 year. Angiographic follow-up was completed in 87% of patients. In the rapamycin group, the drug was well tolerated (26% minor side effects) and was maintained in 96% of patients. At 9 months, the in-segment binary restenosis was reduced by 72% (11.6% rapamycin vs. 42.8% no-therapy group, p = 0.001) and the in-stent binary restenosis was reduced by 65% (12% rapamycin vs. 34.6% no-therapy group, p = 0.009). The in-segment late loss was also significantly reduced with oral therapy (0.66 vs. 1.13 mm, respectively; 43% reduction, p < 0.001). At 1 year, patients in the oral rapamycin group also showed a significantly lower incidence of target vessel revascularization (8.3% vs. 38%, respectively, p < 0.001), target lesion revascularization (7.6% vs. 37.2%, respectively, p < 0.001), and major adverse cardiovascular events (20% vs. 44%, respectively, p = 0.018). This randomized, controlled, and unblinded study showed that the administration of oral rapamycin during 14 days after stent implantation significantly reduces angiographic and clinical parameters of restenosis.
  Journal of the American College of Cardiology 04/2006; 47(8):1522-9. · 14.16 Impact Factor
• Article: Left ventricular remodeling and systolic deterioration in acute myocardial infarction: findings from the Stent-PAMI Study.

  Stephen J Mattichak, Kishore J Harjai, Jacob R Dutcher, Judith A Boura, Gregg Stone, David Cox, Bruce R Brodie, William W O'Neill, Cindy L Grines
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  ABSTRACT: Left ventricular systolic deterioration (LVSD) develops in some patients despite successful percutaneous intervention and medical therapy for myocardial infarction (MI). We sought to determine predictors of LVSD by comparing demographic, procedural, angiographic variables, and 6-month major adverse cardiac events (MACE) in patients with and without LVSD after MI. We performed a posthoc analysis of patients prospectively enrolled in the Stent-PAMI trial if they had successful percutaneous intervention for MI (<50% residual stenosis and TIMI-3 grade flow), normal left ventricular systolic function on index ventriculogram, and protocol driven coronary angiography with ventriculography at 6 months. We defined LVSD as an absolute decrease in ejection fraction > or =15% compared to baseline value. Of the 900 patients enrolled in Stent-PAMI, 187 patients met the inclusion criteria. LVSD developed in 30 patients (16%) and occurred independent of demographic, procedural, angiographic variables, and 6-month MACE. Multivariate predictors of LVSD were higher baseline ejection fraction (P = 0.0065, OR 1.09; 95% CI = 1.02-1.16) and peak creatine phosphokinase (CPK) level (P = 0.0022, OR 1.04; 95% CI = 1.02-1.07). LVSD occurs in a minority of patients despite successful mechanical reperfusion and occurred independent of procedural, angiographic variables, target vessel revascularization, reinfarction, and combined MACE. Infarct size (determined by peak CPK) and high baseline ejection fraction predicted development of LVSD at 6 months. LVSD in this population likely occurred by negative left ventricular remodeling.
  Journal of Interventional Cardiology 08/2005; 18(4):255-60. · 1.18 Impact Factor
• Article: Frequency of returning to work one and six months following percutaneous coronary intervention for acute myocardial infarction.

  Amr E Abbas, Bruce Brodie, Gregg Stone, David Cox, Aaron Berman, Stacy Brewington, Simon Dixon, William W O'Neill, Cindy L Grines
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  ABSTRACT: We conducted an analysis of the frequency and variables associated with early (after 1 month) and late (after 6 months) return to work after percutaneous coronary intervention for acute myocardial infarction in patients who had been randomized in the Stent Primary Angioplasty in Myocardial Infarction trial. Of 450 patients who were employed before the acute myocardial infarction, 230 (51%) returned to work within 1 month with no increases in in-hospital and 1- or 6-month event rates compared with those who did not return to work. Multivariate analysis showed that predictors of early return to work were employment in the United States, no history of smoking, and single-vessel coronary disease. At 6 months, 353 of 435 patients (78%) had returned to work, and multivariate analysis showed that predictors of late return to work were employment in the United States and absence of angina.
  The American Journal of Cardiology 01/2005; 94(11):1403-5. · 3.37 Impact Factor
• Article: Comparison of safety and efficacy between first and second generation of angio-seal closure devices in interventional patients.

  Zoran Lasic, Roxana Mehran, George Dangas, Gary Mintz, Eugenia Nikolsky, Emmanouil Tsounias, Paras C Udani, Milena Adamian, Julia Adamian, Issam Moussa, Michael Collins, Gregg Stone, Jeffrey Moses
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  ABSTRACT: Arterial closure devices are safe and effective in selected patients, with complication rates similar to or lower than manual compression. The purpose of this study was to compare the safety and efficacy of the first- and new-generation Angio-Seal devices in patients undergoing PCI. This study found that the new Angio-Seal STS Platform device can secure hemostasis after PCI in a safe and effective manner similar to the old device. The new platform is easier for the operator and for the patients.
  The Journal of invasive cardiology 08/2004; 16(7):356-8. · 1.84 Impact Factor
• Article: Comparison of differences in outcome after percutaneous coronary intervention in men versus women <40 years of age.

  Alexandra J Lansky, Roxana Mehran, George Dangas, Ecaterina Cristea, Kazuyuki Shirai, Ricardo Costa, Costantino Costantini, Yoshihiro Tsuchiya, Stephane Carlier, Gary Mintz, Yves Cottin, Gregg Stone, Jeffrey Moses, Martin B Leon
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  ABSTRACT: We evaluated the outcomes of 177 consecutive patients (43 women, 134 men) <40 years of age with premature atherosclerosis who underwent percutaneous coronary intervention. Women were younger, had more diabetes mellitus (37% vs 10%; p <0.001), but less hyperlipidemia (58% vs 75%; p <0.001) compared with men. In-hospital vascular complications and 1-year mortality rate or Q-wave myocardial infarction (7.9% vs 0.08%, p <0.01) were higher in women. By multivariable regression analysis, female gender was the only independent predictor of vascular complications (odds ratio, 14.1; 95% confidence intervals, 1.59 to 125, p = 0.01) and of 1-year mortality rate or nonfatal myocardial infarction (odds ratio, 12.5; 95% confidence interval, 1.14 to 111, p = 0.03). Women with premature coronary disease had a distinctive risk factor profile relative to men, with a predominance of diabetes and hypercholesterolemia, and were at higher risk of developing vascular and ischemic complications after percutaneous coronary intervention, warranting aggressive risk factor modification and vigilance in this population.
  The American Journal of Cardiology 04/2004; 93(7):916-9. · 3.37 Impact Factor
• Article: Return to work following percutaneous coronary intervention for acute myocardial infarction

  Abbas AE, Bruce Brodie, Gregg Stone, David Cox, Aaron Berman, Stacy Brewington, William W. O’Neill, Cindy L. Grines
  The American Journal of Cardiology 01/2004; 94(11):1403. · 3.37 Impact Factor
• Article: Implications of the presence and length of "geographic miss" on restenosis and the edge phenomenon in the INHIBIT trial.

  Costantino O Costantini, Alexandra J Lansky, Gary S Mintz, Kazuyuki Shirai, Paul S Teirstein, Gregg Stone, Lynn Vandertie, Brian Proctor, Martin Fahy, Alan Yeung, Albert E Raizner, Ron Waksman, Martin B Leon
  The American Journal of Cardiology 06/2003; 91(10):1261-5. · 3.37 Impact Factor
• Article: Intravascular brachytherapy for native coronary ostial in-stent restenotic lesions.

  Costantino O Costantini, Alexandra J Lansky, Gary S Mintz, Kazuyuki Shirai, George Dangas, Roxana Mehran, Martin Fahy, Steven Slack, Maria Coral, Paul S Teirstein, Ron Waksman, Gregg Stone, Jeffrey Moses, Martin B Leon
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  ABSTRACT: We analyzed the effects of vascular brachytherapy (VBT) on ostial in-stent restenosis (ISR). In-stent restenosis has a high recurrence rate after percutaneous reintervention. The recurrence rate of ostial ISR lesions and the impact of VBT remain unknown. We evaluated 133 patients with native coronary ostial ISR from a pooled database of 990 patients enrolled in randomized VBT trials. Independent quantitative angiography was performed at baseline and follow-up in 45 gamma, 27 beta, and 61 placebo patients. Binary restenosis was significantly higher in placebo than radiated patients (75.4% vs. 17.8% in gamma vs. 22.2% in beta, p < 0.0001). The treatment effect of both gamma (odds ratio [OR] 0.06; 95% confidence interval [CI] 0.02 to 0.17) and beta VBT (OR 0.10; 95% CI 0.03 to 0.31) was maintained after controlling for differences in baseline lesion length. Proximal and distal radiation edge restenosis rates were similar among the groups. Vascular brachytherapy of true aorto-ostial lesions (n = 34) was similarly beneficial: restenosis rates of placebo versus gamma or beta patients of 83.3% versus 6.7% versus 28.6%, p = 0.0002. Conventional treatment of ostial ISR is associated with a recurrence rate of over 75%. Vascular brachytherapy with either gamma or beta sources results in significant and similar reductions in restenosis compared with placebo. Similar benefits after VBT prevail in true aorto-ostial lesions.
  Journal of the American College of Cardiology 05/2003; 41(10):1725-31. · 14.16 Impact Factor
• Article: A Comparison of Tirofiban and Abciximab in Patients Undergoing Coronary Stent Implantation: Rationale, Design, and Results of the TARGET Trial.

  Magdi M. El-Omar, George Dangas, Gregg W. Stone
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  ABSTRACT: Three intravenous glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, and eptifibatide, when administered intravenously just before percutaneous intervention, have been shown to reduce the composite 30-day occurrence of death, myocardial infarction, or urgent target vessel revascularization. These agents differ from each other notably in chemical structure, pharmacokinetics, and pharmacodynamic activity. Whether they are clinically equivalent can be answered only by a well-designed, large scale, head-to-head randomized trial. The TARGET trial prospectively compared the efficacy of abciximab with that of tirofiban as an adjunct to coronary stent implantation in 4809 randomized patients with diverse characteristics. The 30-day results demonstrated that abciximab offered greater protection than tirofiban from major ischemic events, principally due to a significant reduction in peri-procedural myocardial infarction, with the greatest effect seen in patients with acute coronary syndromes. However, by 6 months the differences between the two agents had largely disappeared such that the composite rates of death, myocardial infarction, and target vessel revascularization were similar. The implications of this study on the cost-effective utilization of glycoprotein IIb/IIIa inhibitors are profound.
  Current interventional cardiology reports. 12/2001; 3(4):336-345.
• Article: A comparative analysis of primary stenting and optimal balloon coronary angioplasty in acute myocardial infarction. Six month results from the STENT PAMI trial

  Mattos Luiz Alberto, Grines Cindy L, David Cox, Sousa J. Eduardo, Costantino Costantini, Gregg Stone, Morice Marie C, William O'Neill, Eulógio Garcia, Judith Boura
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  ABSTRACT: OBJECTIVE: To compare the outcome of balloon PTCA with final coronary stenosis diameter (SD) <=30%, with elective coronary stenting. METHODS: We performed a comparative analysis of the 6 month outcomes in patients treated with primary stenting and those who obtained an optimal balloon PTCA result treated during the first 12 hours of AMI onset included in the STENT PAMI randomized trial. RESULTS: The results were analysed into 3 groups: primary stenting (441 patients, SD=22±6%), optimal PTCA (245 patients), and nonoptimal PTCA (182 patients, SD= 37±5%). At the end of the 6 months primary stent group presented with the lowest restenosis(23 vs. 31 vs. 45%, p=0.001, respectively). Ischemia-driven target vessel revascularization rate (TVR) (7 vs. 15.5 vs. 19%, p=0.001, respectively). CONCLUSION: At the 6 month follow-up, primary stenting offered the lowest restenosis and ischemia-driven TVR rates. Compared to optimal balloon PTCA. Nonoptimal primary balloon PTCA pts (SD=31-50%), had the worst late angiographic outcomes and should be treated more actively with coronary stent implantation.
  Arquivos Brasileiros de Cardiologia. 01/2000;